Category Archives: Health

By Cara Anthony, KFF Health News

“Get him off the table,” the doctor recalled telling the surgical team at SSM Health Saint Louis University Hospital as the team cleaned Black’s chest and abdomen. “This is my patient. Get him off the table.”

At first, no one recognized Zohny Zohny in his surgical mask. Then he told the surgical team he was the neurosurgeon assigned to Black’s case. Stunned by his orders, the team members pushed back, Zohny said, explaining that they had consent from the family to remove Black’s organs.

“I don’t care if we have consent,” Zohny recalled telling them. “I haven’t spoken to the family, and I don’t agree with this. Get him off the table.”

Black, his 22-year-old patient, had arrived at the hospital after getting shot in the head on March 24, 2019. A week later, he was taken to surgery to have his organs removed for donation — even though his heart was beating and he hadn’t been declared brain-dead, Zohny said.

Black’s sister Molly Watts said the family had doubts after agreeing to donate Black’s organs but felt unheard until the 34-year-old doctor, in his first year as a neurosurgeon, intervened.

Today, Black, now 28, is a musician and the father of three children. He still needs regular physical therapy for lingering health issues from the gun injury. And Black said he is haunted by what he remembers from those days while he was lying in a medically induced coma.

“I heard my mama yelling,” he recalled. “Everybody was there yelling my name, crying, playing my favorite songs, sending prayers up.”

He said he had tried to show everyone in his hospital room that he heard them. He recalled knocking on the side of the bed, blinking his eyes, trying to show that he was fighting for his life.

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Organ transplants save a growing number of lives in the U.S. every year, with more than 48,000 transplants performed in 2024, according to the Organ Procurement and Transplantation Network, which oversees the nation’s transplant system. And thousands die awaiting donations that never come.

But organ donation has also faced ongoing criticism, including reports of patients showing alertness before planned organ harvesting. The results of a federal investigation into a Kentucky organ donation nonprofit, first disclosed by The New York Times in June, found that during a four-year period, medical providers had planned to harvest the organs of 73 patients despite signs of neurological activity. Those procedures ultimately didn’t take place, but federal officials vowed in July to overhaul the nation’s organ donation system.

“Our findings show that hospitals allowed the organ procurement process to begin when patients showed signs of life, and this is horrifying,” Health and Human Services Secretary Robert F. Kennedy Jr. said in a statement. “The entire system must be fixed to ensure that every potential donor’s life is treated with the sanctity it deserves.”

Even before this latest investigation, Black’s case showed Zohny that the organ donation system needed to improve. He was initially hesitant to talk to KFF Health News when contacted in July about Black. But Zohny said his patient’s story had stuck with him for years, highlighting that while organ donation must continue, little is understood about human consciousness. And determining when someone is dead is the critical but confusing question at play.

“There was no bad guy in this. It was a bad setup. There’s a problem in the system,” he said. “We need to look at the policies and make some adjustments to them to make sure that we’re doing organ donation for the right person at the right time in the right place, with the right specialists involved.”

LJ Punch, a former trauma surgeon who was not involved with the case but reviewed Black’s medical records for KFF Health News, questioned whether Black’s injury — from gunfire — possibly contributed to how he was treated. Young Black men like Larry Black are disproportionately victims of gun trauma in the United States, and research on such violence is scant. His experience exemplifies “the general neglect” of Black men’s bodies, Punch said.

“That’s what comes up for me,” Punch said. “Structurally, not individually. Not any one doctor, not any one nurse, not any one team. It’s a structural reality.”

The hospital declined to comment on the details of Black’s case. SSM Health’s Kim Henrichsen, president of Saint Louis University Hospital and St. Mary’s Hospital-St. Louis, said the hospital system approaches “all situations involving critical illness or end-of-life care with deep compassion and respect.”

Mid-America Transplant, the federally designated organ procurement organization serving the St. Louis region, does not comment on individual donor cases, according to Lindsey Speir, executive vice president for organ procurement. She did tell KFF Health News that her organization has walked away from cases when patients’ conditions change — though not as late as when they are in the operating room for harvesting.

“Let me be clear about that. It happens way before then,” she said. “It definitely happens multiple times a year where we get consent. The family has made the decision, we approach, we get consent, it’s all appropriate, and then a day or so later they improve and we’re like, ‘Whoa.’”

But Speir said the recent media stories about the nation’s donation system are prompting a lot of questions about a process that also does a lot of good.

“We’re losing public trust right now,” Speir said of the industry. “And we’re going to have to regain that.”

Blink Twice for a Chance at Life

Larry Black Jr. and his sister Molly Watts are still trying to process everything that happened to him while he was hospitalized in 2019 at SSM Health Saint Louis University Hospital.

It was a Sunday afternoon when gunshots rang out in downtown St. Louis. Black had been on his way to his sister’s apartment.

“I didn’t know I was shot at first,” Black said, sitting in his living room six years later. “I literally ran like a block or two away.”

He collapsed moments later, he said, crawling to the back door of a woman’s home, where he asked for help. He said he asked the woman to give him two large towels, one covered in rubbing alcohol and another soaked with hydrogen peroxide. He wrapped those towels around the back of his head.

When his sister Macquel Payne found him, he was lying on the ground near the leasing office of her apartment complex, a crowd gathered around him.

Before an ambulance took him to the hospital, Black told his sister not to worry about him.

“I’m hearing Larry say, ‘I’m good, sis,’” Payne recalled. “‘I’m OK.’”

Black said he went in and out of consciousness on the way to the hospital and once he was there.

“I got to hitting my hand on the side of the ICU bed,” Black said. “They was like: ‘That’s just the reaction, the side effects of the medicine. Ask him some questions.’”

Payne said she asked her brother to blink twice if he could remember his first pet, a dog named “Little Black” that looked like the Chihuahua from the Taco Bell commercials.

Black said he remembers blinking twice. His sisters remember the same.

Payne asked him another question. This time she wanted to know whether her brother recognized their family. Black said he blinked twice when he saw his mom and sister standing nearby.

Black said his sister then asked him “the main question” that everyone needed him to answer.

“She’s like, ‘If you want them to pull a plug, if you tired and you giving up, blink once,’” Black recalled. “‘If you still got some fight in you, blink more than once.’”

Black said he started blinking and hit the bed to let his family know that he was still with them.

The sisters said hospital staffers told them the movements were involuntary.

‘Not Right Now’

In a waiting room steps away from the hospital’s intensive care unit, a woman carrying brochures explained to Payne and the rest of the family that Black had identified himself as a possible organ donor on his ID.

The woman wanted to know whether the family wished to move forward with the process if Black died, Payne said.

“I remember my mom saying, ‘Not right now,’” Black’s sister recalled. “‘It’s kind of too soon.’”

Payne said the woman persisted.

“She was like, ‘Well, can I at least leave you some brochures or something?’” Payne recalled. “Then my mom got a little agitated because it felt like she was being, like, pushy.”

The family was already acquainted with the organ donation process. In 2007, Black’s teenage brother Miguel Payne drowned at a local lake. His organs were donated, Macquel Payne said, noting the family was told that his body parts and tissues helped multiple people.

“I believe in saving lives,” Payne said. “But don’t be pushy about it.”

Zohny Zohny recently started a medical research company called Zeta Analytica to explore ways of quantifying consciousness, inspired in part by his experience with Larry Black Jr. in 2019. He also will be joining the West Virginia University Rockefeller Neuroscience Institute in October.

Mid-America Transplant handles the organ transplant process for 84 counties in parts of Illinois, Arkansas, and Missouri, including St. Louis. Like the Kentucky organization, it is one of 55 federally designated nonprofits that facilitate organ donations throughout the country.

The nonprofit has never pressured a family into organ donation, Speir said. Registering to be an organ donor is legally binding, she said, but Mid-America has walked away from cases when families didn’t want to move forward.

She said her staff tries to dispel myths about organ donation and alleviate concerns. “We want to have the families leave with a positive experience,” Speir said.

Despite the family’s initial ambivalence, they ultimately consented to moving forward with donating Black’s organs. Watts said members of her brother’s care team had told the family that her brother was at “the end of the road.”

The family was told to prepare for Black’s “last walk of life,” Payne said. Also known as an honor or hero’s walk, the tradition honors the life of an organ donor before the harvesting process begins.

At the time, Payne said, she thought her brother still had a fighting chance. She asked the hospital staffers to take another look at him before he was wheeled down the hall.

“I’m like, ‘My brother’s in there tapping on the bed,’” Payne said. “They said, ‘That’s just his nerves.’ But I’m like, ‘No, something’s not right.’ It’s like he was too alert. He was letting us know: ‘Please don’t let them do this to me. I’m here. I can fight this.’ They were saying that’s what the medicine will do, it affects his nerves.”

After the family had agreed to move forward with the organ donation process, the two sisters said, an especially helpful member of Black’s medical team no longer treated them the same way. She became standoffish, they said.

“You could tell the dynamics had changed,” Watts said.

‘#RIPMyBrother’

The family put on blue jumpers for the walk of life. “We just walked around the floor, and everybody was, like, acknowledging him,” Payne said. “We just thought this was the end.”

A friend Black went to high school with filmed part of the ritual. In a short clip, Black is seen being wheeled on a stretcher down a hallway in the hospital. His eyes are half-open. People are crying.

False rumors then started to swirl outside the hospital.

Macquel Payne was among the family members at SSM Health Saint Louis University Hospital when her brother Larry Black Jr. was being prepped to have his organs harvested in 2019.

Lawrence Black Sr. says he refused to believe that his son, Larry Black Jr., was dead in 2019 when he heard a rumor that his son’s body was being taken to the SSM Health Saint Louis University Hospital morgue. He says he prayed for his son to live. Today, his son is walking, talking, and the father of three children.

Brianna Floyd said she went into shock when she heard that her friend was dead. She knew that Black had been shot in the head. But a few days earlier, a local newspaper had reported that he was in stable condition.

Floyd checked Facebook to see whether the news of his death was true. Her timeline was flooded with farewell posts for Black, so she decided to write one, too.

“I Love You So Much Brother,” Floyd wrote. “#RIPMyBrother. Never Thought I Would Say That.”

Black’s father rushed to the hospital when he heard a rumor that his son was being wheeled to the morgue.

“‘He’s gone,’” Lawrence Black Sr. recalled being told. “‘He’s going to the freezer now.’”

Black Sr. said he refused to believe that his son was dead. The thought was devastating. He had already experienced that kind of loss to gun violence.

“You wake up and nothing’s the same,” Black Sr. said. “The spirit is lingering for about a week, and you can feel it, you know?”

Overwhelmed with emotion, he prayed for his son to live.

‘I Can’t Kill Your Son’

Zohny, the neurosurgeon, said he heard an announcement about a “hero’s walk” over a loudspeaker in the hospital. He wasn’t familiar with the term, so he asked about it. Medical residents in the hospital explained and told Zohny that the walk was possibly for his patient Larry Black.

“No, that can’t be my patient,” Zohny said he told them. “I didn’t agree.”

That’s when Zohny called the ICU to check on Black’s status. A person who answered the phone told him that Black was being wheeled to an operating room, he said.

“This is my first year,” Zohny said. “Your first year out as a neurosurgeon is the riskiest time for you. Any mistakes, anything small, basically derails your career. So the moment this happened, my legs went weak and I was very nervous because, at the end of the day, your job as a doctor is to be perfect.”

KFF Health News, Zohny, and Punch all reviewed the medical files given to Black from his hospitalization. It’s not clear from the records what led to that moment.

“In every case, the patient must be declared legally dead by the hospital’s medical team before organ procurement begins. This is not negotiable,” Mid-America Transplant’s CEO and president, Kevin Lee, wrote in an Aug. 21 blog post on the nonprofit’s website, responding to the news and federal comments about the investigation centered in Kentucky. “Mid-America Transplant strictly follows all laws, regulations, and hospital protocols throughout the process.”

He said in a statement to KFF Health News that a person can be pronounced dead in two ways. A person is legally dead if their heart stops beating and they stop breathing, which is when donation after cardiac death can occur. A person can also become an organ donor if their brain, including the brain stem, has irreversibly ceased functioning, which is when brain death donation can occur.

Zohny Zohny (left), a neurosurgeon, stands with his patient Larry Black Jr. and Black’s sister Molly Watts in a photograph taken at a follow-up medical appointment in 2019. Black was shot in the head in St. Louis earlier that year.

“Every hospital has their own process in declaring both types of death,” Speir said in a statement. “Mid-America Transplant ensures hospitals follow their policies.”

But Black didn’t fall into either category, Zohny said. And, he said, Black hadn’t had what is known as a brain death exam.

Zohny said he immediately informed his chairman about the situation, then started running to the operating room. Black’s family was waiting in the hallway, unaware of the drama happening behind a set of closed silver doors.

Then Zohny emerged, pulling Black’s family into an empty operating room that was nearby.

“I remember he told my mama, ‘I can’t kill your son,’” Payne recalled. “She said, ‘Excuse me?’”

Zohny put an image of Black’s brain on a screen. Then he circled the part of his brain that was damaged. He explained that Black’s gunshot wound was something that he could possibly recover from, though he might need therapy. He asked the family whether they were willing to give Black more time to heal from the injury, instead of withdrawing care.

“In my opinion, no family would ever consent to organ donation unless they were given an impression that their family member had a very poor prognosis,” Zohny said. “I never had a conversation with the family about the prognosis, because it was too early to have that discussion.”

Zohny knew that he was taking a professional risk when he ran into the operating room.

“The worst-case scenario for me is that I lose my job,” he recalled thinking. “Worst-case scenario for him, he wrongfully loses his life.”

Later, Zohny said, a hospital worker who transported Black from the ICU to the operating room told Zohny that something had seemed off.

“I remember him looking at me and saying, ‘I’m so glad you stopped that,’” Zohny recalled. “And I said, ‘Why?’ And he said: ‘I don’t know. His eyes were open the whole time, and I just felt like he was looking at me. His eyes didn’t move, but it felt like he was looking at me.’”

‘Back From the Dead’

After Zohny’s intervention, Black was wheeled back to the ICU. Zohny said the medical team held back all medications that caused his sedation.

Black woke up two days later, Zohny said, and started speaking. Within a week, the neurosurgeon said, he was standing.

“I had to learn how to walk, how to spell, read,” Black said. “I had to learn my name again, my Social, birthday, everything.”

Zohny continued to care for Black during what remained of his 21 days in the hospital. During a follow-up appointment, he posed for a photo with Black and his older sister, Watts. Next to Zohny, Black is standing up, a brace on his leg.

“It’s a miracle that despite flawed policy we were able to save his life,” Zohny said. “It was an absolute miracle.”

To help Larry Black Jr. process his gunshot injuries and an aborted surgery to harvest his organs in 2019, he makes music under the name BeamNavyLooney. “I am back from the dead,” he recently wrote in a song about his experience.

Zohny, who was working as a fellow and assistant professor at the time, left Saint Louis University Hospital for another job later that year when his fellowship ended. He said Black’s story made him question what we know about consciousness.

He’s now working on a new method that quantifies consciousness. Zohny said it could possibly be used to help measure consciousness from brain signals, such as with an electroencephalogram, or EEG, a test that measures electrical activity in the brain. Zohny said his method still needs rigorous validation, so he recently started a medical research company called Zeta Analytica, separate from his work at the West Virginia University Rockefeller Neuroscience Institute, which he’ll begin in October.

“We don’t understand the brain to the level that we should, especially with all of the technology we have now,” Zohny said.

Today, Black is trying to move forward. He said he has seizures if the bullet fragments in his head move around too much. He said he easily overheats because of the injury.

He doesn’t blame his family for their decision. But he questions the organ transplantation process. “It’s like they choose people’s destiny for them just because they have an organ donor ribbon on their ID,” Black said. “And that’s not cool.”

To help him process everything that happened to him in 2019, he makes music under the name BeamNavyLooney. “I am back from the dead,” he recently wrote in a song about his experience.

Earlier this year, Black celebrated the birth of another son, who was sleeping peacefully at home as Black recounted his story.

“He doesn’t really cry,” Black said. “He just makes noises.”

Black sat with a firearm within reach. He said he keeps the gun close to protect his family. It’s still hard for him to sleep at night. Nightmares about what happened — both on the street and in the hospital — keep him awake.

He said he no longer wants to be on the organ donor registry.

Republished with permission under license from KFF Health News.

Access to Justice, Health, Protest

She Can’t Sue Her Doctor Over Her Baby’s Death. When She Spoke Out, She Was Silenced Again.

April 12, 2021 MuniCourts

by Carol Marbin Miller and Daniel Chang, Miami Herald

ORLANDO, Florida — On the day Reggie Jacques was born, doctors at Winnie Palmer Hospital in Orlando told his parents that there was no hope, that his brain had gone too long without oxygen during his difficult birth. But Reggie refused to die.

On his sixth day, said parents Jean and Ruth Jacques, doctors urged them to remove Reggie from his ventilator. They said he would surely stop breathing. The couple agreed a month later. But Reggie wouldn’t die.

Around day 60, doctors asked the couple to sign a “do not resuscitate” order. They declined. And Reggie still refused to die.

For 95 days, Reginald Jacques refused to die.

But on the 96th day, Sept. 19, 2016, something felt wrong. Ruth Jacques surrendered to an irresistible impulse to hold her son after a day’s work for an Orange County social services agency. “I was driving the car like a madwoman,” Jacques said of her early evening trip to the hospital.

Jacques flew through red lights. Uncharacteristically, she left her car in a parking space for disabled drivers. She ran up three flights of stairs to the Neonatal Intensive Care Unit, where, she said, Reggie’s monitor was beeping, and he appeared to be in distress.

She picked up her infant son from his bassinet — all tubes and bandages and chirping monitors — and placed him gently on her chest. “With the little strength he had left, he lifted up his head and looked back at me,” she said.

“One minute later, his heart stopped. It was more like our heart stopped.”

Four years later, Ruth Jacques’ heart beats for two as she wages a campaign to demand answers from the doctor who delivered her son. She believes Florida’s state-sponsored Birth-Related Neurological Injury Compensation Association, or NICA, robbed her of the right to seek justice through the courts for the harm he suffered at birth and three months of agony as he fought for life.

Florida lawmakers created NICA in 1988, responding to obstetricians’ complaints that their malpractice insurance premiums were too high. The law bars parents like Jean and Ruth Jacques from pursuing lawsuits against doctors and hospitals when a baby is born with catastrophic, even fatal, brain damage from oxygen deprivation or asphyxia during childbirth.

Ruth and Jean Jacques filed a complaint with the Florida Department of Health about the doctor who delivered their son Reggie. They said they received a form letter back saying the doctor’s actions did not violate the profession’s “standard of care.” Credit:Photo courtesy of Jacques family

If the birth injury meets NICA criteria, even in cases where the doctor or hospital may have made a glaring error, parents typically have little choice but to forgo a lawsuit and accept the program’s compensation, which consists of a $100,000 settlement upfront, and “medically necessary” and “reasonable” health care for the duration of the child’s life.

If the child dies, there is an added $10,000 funeral benefit.

The Jacqueses hoped to sue their obstetrician and hospital for negligence, only to learn from their attorney of the law that created NICA. Stripped of that right, they settled for filing a malpractice complaint with the Health Department. They received a form letter saying their complaint had been dismissed because the doctor’s actions did not violate the profession’s “standard of care.” There was no further explanation. Ruth Jacques said neither she nor her husband was interviewed by investigators.

The Jacqueses cannot appeal the investigation’s outcome, or even read about it, beyond the form letter. In Florida, those records are sealed and available only to the doctor.

That wasn’t the state’s only betrayal, Ruth Jacques said.

The day after Reggie’s death, overcome by anger and despair, she did the only thing she could think of: She printed leaflets warning prospective patients to stay away from Dr. Ricardo Lopez, the obstetrician who delivered Reggie. She said she handed them out in front of his Orlando medical office — and distributed a few to patients in his waiting room.

“I felt like the world was shutting me up,” she said. “I wanted to be heard.”

Ruth Jacques said she was silenced again. She learned that Lopez was free to do what she could not: file a lawsuit. Her attorney told her if she persisted in protesting she might end up a defendant.

A lawyer for Orlando Health, which owns Winnie Palmer and employs Lopez, wrote to the Jacqueses’ lawyer in January 2017: “I respectfully demand that Ms. [Jacques] cease and desist from further attacks on Dr. Lopez and [the hospital] regarding this matter.” Then the couple’s lawyer wrote to Ruth Jacques.

“I understand your anger,” the lawyer explained in an email. But, she added, “Any kind of verbal attack or public complaint about Dr. Lopez or Orlando Health could lead them to sue you and your husband personally.”

Lopez, who did not sue, declined to respond to the Miami Herald’s requests for an interview, forwarding the inquiry to Orlando Health.

Alayna Curry, an Orlando Health spokeswoman, said the hospital would not discuss Reggie’s calamitous birth, even though his mother has.

“Our medical team respects the wishes of our patients when it comes to their delivery experience,” she said in a prepared statement. “When a medical emergency arises during a delivery, time is of the essence and our physicians will speak with the patient about the recommended course of action.”

“You Better Push”

There is sharp disagreement over precisely what was said and when inside the delivery room.

Ruth Jacques provided the Herald a copy of her medical records, which contain a notation from Lopez that, based on “severe” fetal heart recordings, “a C-section was offered.”

“The patient refused,” Lopez wrote.

A nurse also reported “Pt refused C-section” in a notation dated two days after Reggie was delivered.

Jacques said she did no such thing, and the records do not contain a signed form from the mother refusing a C-section. The form is considered an industry “best practice,” but not a requirement.

In a 2017 letter to the state Health Department, Ruth Jacques said she insisted that Lopez never told her Reggie’s life was in danger.

“You better push, or you’re going to have a C-section,” she said she was told by the doctor. “In my understanding, he is threatening me [with] a C-section if I don’t push, not that the situation … was an emergency.”

Ruth Jacques did continue pushing, according to her medical records. Lopez attempted to deliver Reggie using a vacuum device, which popped off the infant’s head three times before the fourth pull succeeded.

Dr. Nicole Smith, medical director of maternal fetal medicine practice at Brigham and Women’s Hospital, Harvard Medical School’s teaching hospital in Boston, said in general the responsibility lies with doctors to explain their rationale and the benefits and risks of continuing in labor or moving to a surgical delivery.

“Mothers maintain the right to decline a C-section,” Smith said in an email, “but it is the provider’s responsibility to ensure that they understand the risks and benefits to the extent possible in what is typically a highly stressful situation.”

Smith did not review Ruth Jacques’ case or comment on the delivery.

Ethical guidelines of the American College of Obstetricians and Gynecologists also place the onus on the obstetrician to provide the patient with “adequate, accurate and understandable information.”

The group advises, however, that even a signed form does not guarantee that the ethical obligations of informed consent have been met.

Reggie’s parents believe their son would have lived had Lopez initiated a timely C-section, potentially preventing Reggie’s brain from being starved of oxygen. But they will never really know.

Like many NICA families, the Jacqueses said they had no idea that they had lost their right to file suit.

Ruth Jacques said she signed forms acknowledging that her doctor and the hospital had informed her of NICA before Reggie’s birth. But she didn’t read them. She said her OB-GYN had her sign them on her first appointment. At the hospital, the forms were tucked inside a stack of documents handed to her when she showed up in labor, distracted by impending motherhood, too late to change her mind and seek out another hospital.

After they lost Reggie and learned that a lawsuit was foreclosed, the couple said their sorrow would turn to outrage when they discovered that Lopez had a history with NICA.

Aside from Reggie’s case, the doctor has been named in four NICA claims, including two petitions filed prior to Reggie’s death. Not every NICA claim is accepted for compensation. But one of the first two lodged against Lopez was.

Two other claims were submitted after Reggie died. Those two were rejected because the newborns weighed less than 5.5 pounds — the legal threshold to qualify for NICA, a requirement intended to eliminate very premature babies from eligibility. In the case of a rejected claim, the family can sue. But none of the rejected claims has been followed by a lawsuit.

Being named in a petition does not mean a doctor committed malpractice — even if the claim is compensated. It only means that the case meets the narrow criteria of the no-fault program.

Bonded by Sorrow

If NICA families are members of an unenviable fraternity, families whose child died are its saddest chapter.

A total of 1,238 NICA claims have been made from the inception of the program through the beginning of April. NICA said at least 440 of those were accepted for coverage, which includes at least 143 from parents whose child had died by the time the claim was accepted.

Another 50 children whose claims were accepted for compensation died after they entered the program, NICA said in an email. Among those 50, the average life span after acceptance was 8.2 years. The oldest lived 29 more years. The youngest survived one day after the claim was accepted.

For some parents, NICA cannot provide what they want most: accountability.

There are practical considerations, said David Studdert, a Stanford University professor and expert in health law who co-authored a study of NICA in 2000.

Some of those families who were accepted into NICA likely would have gotten nothing had they been allowed to pursue a lawsuit.

But there is catharsis in discovering what went wrong, who is responsible — even in just being heard — said Kenneth Feinberg, a lawyer who has designed and administered compensation funds in the wake of some of America’s worst tragedies: the Virginia Tech massacre, the Sandy Hook Elementary shooting, the rampage at Pulse nightclub, Sept. 11.

The fund established after the Sept. 11 attacks was entirely voluntary, and 97% of eligible claimants opted to take the money, Feinberg said, forfeiting the right to sue. The program had an unusual feature: Claimants could appear before Feinberg or a staff member behind closed doors to express their grief; 1,500 did.

“All kinds of people came to vent, angry, not at the federal government. Angry at God,” Feinberg said.

Feinberg said many described the program as an exercise in justice, but he saw it differently. “I don’t think those words have much meaning when you’ve lost a loved one,” he said. “The best word I use is mercy.”

Reggie Never Cried

Jean Jacques’ father died in March 2015, on the same day the couple returned from their Caribbean honeymoon cruise, leaving them despondent and Jean Jacques as the lone male heir. They decided they wanted to become parents right away. They were hoping for a boy, someone to carry forward Jean Jacques’ father’s last name and legacy.

They found a house suitable for raising kids. Ruth Jacques’ family threw a baby shower. They painted the walls of Reggie’s nursery teal and gray, bought a brown crib and attached stickers of giraffes, lions and zebras to the walls.

On the morning of June 14, 2016, Ruth Jacques went to see her obstetrician for a regularly scheduled appointment. She said there was no indication that Reggie was ready for delivery. She drove to work at the social services agency where she was a neighborhood coordinator.

But the next morning, she woke up with a fever and tremors, so she went to Orlando Health Winnie Palmer Hospital for Women & Babies. There, her water broke, and she went into labor. Lopez had not been her obstetrician previously but was there for childbirth.

To Ruth Jacques’ ears, Lopez was accusing her of failing to adequately push what she later learned was a 10-pound baby.

When Reggie finally was born, he was essentially lifeless. His first two Apgar scores — measures of his vitality, on a scale of one to 10 — were zero and zero. He required four doses of epinephrine to start his heart.

Jean Jacques and Reggie. Credit:Photo courtesy of Jacques family

“Normal babies, when they are born, they cry, they open their eyes,” said Jean Jacques, an Orange County Schools paraprofessional and full-time student at the University of Central Florida. Reggie did not cry.

He was placed on a ventilator — which doctors would recommend unplugging six days later, Ruth Jacques said. Bereft of answers, Ruth and Jean Jacques asked for a meeting.

It took place a week after Reggie’s birth, in a conference room near the intensive care unit, with a U-shaped wooden table. Ruth Jacques’ father, sisters, aunt and the family’s pastor joined the couple. She recalls a hospital lawyer standing against a wall opposite her and Lopez sitting at the head of the table, his arms folded across his chest. He didn’t look at her, she said. The doctor barely spoke.

What happened? she asked. Why was her baby on a ventilator with little to no hope of survival?

“He looked at me in the eye, and he said: ‘You did not want to have a C-section,’” Ruth Jacques said.

“And I said to him: ‘So, are you implying that I killed my baby?’”

Ruth Jacques said the doctor unfolded his arms and wrapped one under his cheek. He didn’t answer.

When the meeting adjourned, Ruth said, she met separately with a Winnie Palmer neurologist. “I was informed that my child would ‘never walk, talk or ever be able to do anything for himself. He would live in a vegetative state.’ ”

At first, the couple resisted removing life support. “We were praying that God would help,” she said.

But the strain became unbearable, the couple said. They said one doctor told them: “If you really believe in God, why would you do that to your child?” The family relented.

“That was the hardest decision for us to make,” Jean Jacques said.

Ruth and Jean Jacques and extended family members gathered round the newborn as a musician played soft and somber notes on a guitar. Someone recorded Reggie’s heartbeat on a disc and handed it to his father. A doctor shut off the ventilator, then pulled the breathing tube from Reggie’s mouth and throat, the parents said.

Reggie gulped for air. His mother covered her ears to muffle the sound of his gasping. Jean Jacques paced the floor. The couple fixated on Reggie’s heart monitor and the clock just above it. It seemed like hours, they said. And then, unexpectedly, Reggie began to breathe on his own.

His Finest Outfit

Reggie lived another two months. He never left the hospital.

He wore his finest dress-up clothes only once — the day his parents buried him.

He was laid to rest inside an impossibly small white coffin, dressed in a short-sleeved, buttoned-down shirt and a tie that was too big for his slender body. The tie and shirt were both white, the color of purity.

The couple buried Reggie far from their home, at Greenwood Cemetery. They didn’t want Ruth Jacques visiting her son daily. She needed time to heal.

But a year after her son’s death, Ruth Jacques took a job as a grants coordinator with Orange County’s government downtown, which is near Greenwood, a historic cemetery. Her son’s graveyard is visible from her office. The boy who lived 96 days was laid to rest near Orlandoans whose full lives gave them prominence, including a U.S. senator and two mayors.

Jean and Ruth Jacques preserved Reggie’s short life in pictures: His arms and legs stretched out like a wooden puppet from the contractures — a shortening and hardening of muscles and tendons — that brain damage wrought. An oxygen tube extended from his nostrils. In one photo, he appears to be looking directly at the camera, though the doctors had said he was incapable of such purpose.

Ruth Jacques found direction in her son’s death, vowing not to let the same thing happen to other parents.

She took to her keyboard, writing to state lawmakers. And to the Florida Justice Association, a group of lawyers who represent litigants like her. Her email to the trial lawyers recounted Reggie’s birth and death in detail. It covered seven pages and said Reggie “will always be a memory of a scar that will never truly heal.” There was no response, she said.

She wants Lopez to remember, as well. And so, she said, every year on Reggie’s birthday — and on the anniversary of his death — she files a new complaint with the Department of Health. It’s a symbolic act, but she wants to remind the doctor that Reggie lived, and that he died.

“He is going on with his life, while we the families are stuck on yesterday.”

Jean and Ruth Jacques, now 35 and 32, live in a modest home in Orlando. They’re raising the little brother Reggie never got to know, 3-year-old Raphael. Another child, Reynaud, was born on Jan. 15. The money she received from NICA will never replace the loss, Ruth Jacques said.

“That’s blood money,” she said. “It’s not going to bring him back.”

Every year on the anniversary of her son’s death, Ruth Jacques files a new complaint with the Florida Department of Health, she said. It is a symbolic gesture. The department has already dismissed the complaint. Credit:Photo courtesy of Jacques family

Republish with permission under license from ProPublica.

Health, Race

Racial discrimination ages Black Americans faster, according to a 25-year-long study of families

December 9, 2020 MuniCourts

by Sierra Carter, Georgia State University

The Research Brief is a short take about interesting academic work.

The big idea

I’m part of a research team that has been following more than 800 Black American families for almost 25 years. We found that people who had reported experiencing high levels of racial discrimination when they were young teenagers had significantly higher levels of depression in their 20s than those who hadn’t. This elevated depression, in turn, showed up in their blood samples, which revealed accelerated aging on a cellular level.

Our research is not the first to show Black Americans live sicker lives and die younger than other racial or ethnic groups. The experience of constant and accumulating stress due to racism throughout an individual’s lifetime can wear and tear down the body – literally “getting under the skin” to affect health.

These findings highlight how stress from racism, particularly experienced early in life, can affect the mental and physical health disparities seen among Black Americans.

Anti-racism protest, 2020. Fabrice Coffrini/AFP via Getty Images

Why it matters

As news stories of Black American women, men and children being killed due to racial injustice persist, our research on the effects of racism continue to have significant implications.

COVID-19 has been labeled a “stress pandemic” for Black populations that are disproportionately affected due to factors like poverty, unemployment and lack of access to health care.

Young black mother comforting sad school age daughter at home. — Racism has a far-reaching impact on children’s health. skynesher/E+ via Getty Images

In 2019, the American Academy of Pediatrics identified racism as having a profound impact on the health of children, adolescents, emerging adults and their families. Our findings support this conclusion – and show the need for society to truly reflect on the lifelong impact racism can have on a Black child’s ability to prosper in the U.S.

How we do the work

The Family and Community Health Study, established in 1996 at Iowa State University and the University of Georgia, is looking at how stress, neighborhood characteristics and other factors affect Black American parents and their children over a lifetime. Participants were recruited from rural, suburban and metropolitan communities. Funded by the National Institutes of Health, this research is the largest study of African American families in the U.S., with 800 families participating.

Black man concentrates while completing a form. — Early experiences of racism can have long-term physical effects. PamelaJoeMcFarlane/iStock via Getty Images Plus

Researchers collected data – including self-reported questionnaires on experiences of racial discrimination and depressive symptoms – every two to three years. In 2015, the team started taking blood samples, too, to assess participants’ risks for heart disease and diabetes, as well as test for biomarkers that predict the early onset of these diseases.

We utilized a technique that examines how old a person is at a cellular level compared with their chronological age. We found that some young people were older at a cellular level than would have been expected based on their chronological age. Racial discrimination accounted for much of this variation, suggesting that such experiences were accelerating aging.

Our study shows how vital it is to think about how mental and physical health difficulties are interconnected.

What’s next

Some of the next steps for our work include focusing more closely on the accelerated aging process. We also will look at resiliency and early life interventions that could possibly offset and prevent health decline among Black Americans.

Due to COVID-19, the next scheduled blood sample collection has been delayed until at least spring 2021. The original children from this study will be in their mid- to late 30s and might possibly be experiencing chronic illnesses at this age due, in part, to accelerated aging.

With continued research, my colleagues and I hope to identify ways to interrupt the harmful effects of racism so that Black lives matter and are able to thrive.

Republished with permission under license from The Conversation under a Creative Commons license.

Health, Homelessness, Housing

What the CDC eviction ban means for tenants and landlords: 6 questions answered

September 7, 2020 MuniCourts

by Katy Ramsey Mason, University of Memphis

Editor’s note: The Centers for Disease Control and Prevention issued an order on Sept. 1 banning evictions of people who lost work as a result of the pandemic. To benefit, renters must sign a declaration that they don’t make more than US$99,000 a year or $198,000 for those filing a joint return and that they essentially have no options other than homelessness. But the order, which takes effect on Sept. 4, leaves some questions unanswered. We asked Katy Ramsey Mason, an assistant professor of law and director of the University of Memphis Medical-Legal Partnership Clinic, to answer some of them.

The CDC order may offer some tenants breathing room. Angela Weiss/AFP via Getty Images

1. What does the order do?

The order prohibits property owners from evicting covered tenants from any residential property because of nonpayment of rent before Dec. 31, 2020. It does not apply to any evictions that might be brought on grounds other than nonpayment, such as nuisance or alleged criminal activity.

It requires tenants to sign and submit a declaration to the landlord certifying under penalty that they qualify for protection under the moratorium. It does not relieve tenants from the obligation to pay rent – all of it comes due on Jan. 1, 2021 – and it allows landlords to continue to charge late fees and other penalties as permitted by law.

2. Who qualifies?

The CDC’s order applies to as many as 40 million renters across the country who could be at risk of eviction for nonpayment of rent.

It is more comprehensive than the Coronavirus Aid, Relief and Economic Security (CARES) Act eviction moratorium, which expired on July 24 and only applied to an estimated 12.3 million renters, or about 28% of rental properties nationwide. The new order applies to tenants who live in any rental property in any place in the U.S. and its territories that does not already have an eviction moratorium with the same or greater protections than the CDC order. There are still 20 states with some form of a moratorium in place, about half of which are more comprehensive than the CDC’s moratorium. All of those moratoriums are unaffected.

Other than the financial requirements, to qualify for relief under the CDC order a tenant must certify that he or she is not able to pay full rent due to substantial income loss and has attempted to obtain government assistance with rent, and must commit to making partial rent payments to the extent of his or her ability.

3. What authority does the CDC have to do this?

The CDC is invoking its powers under federal law to take action to prevent the spread of communicable disease if it finds that state or local prevention measures are insufficient. The order emphasizes the link between homelessness and the spread of COVID-19 and states that the high levels of homelessness that would result from widespread evictions would increase the risk of interstate transmission of the virus.

4. What does it mean for landlords?

The CDC’s order is certain to be unwelcome news for many landlords, who have already been struggling through the pandemic.

Many tenants have been unable to pay rent, and nonpayment evictions have been limited by state moratoriums and the coronavirus relief bill. According to the 2015 American Housing Survey, slightly less than half of rental properties are owned by “mom and pop” landlords, while the rest are owned by business entities. If landlords are not able to pay their mortgages and other costs, it could result in a loss of affordable housing units across the country.

Under the CDC’s order, landlords can continue to collect rent and charge late fees and other penalties, but they cannot evict tenants who don’t pay. The order also does not allocate any additional funding to assist tenants or landlords with unpaid rent, but encourages local governments to use coronavirus relief funds that have already been distributed towards rental assistance programs.

5. How will it be enforced?

Unlike the CARES Act moratorium, which had no enforcement mechanism, the CDC eviction moratorium imposes significant criminal penalties on violators. An individual who violates the order can be fined up to $100,000 and/or one year in jail. If a death results from the violation, the fine increases to up to $250,000.

If an organization or company violates the order, the monetary fines increase to a maximum of $200,000 if there is no death and $500,000 if there is a death. The order authorizes the Department of Justice to “initiate court proceedings” to seek those penalties.

6. What happens when the order expires?

When the order expires on Dec. 31, landlords will again be able to initiate eviction proceedings in accordance with state law – unless the moratorium is extended. If tenants have been unable to pay their full rent up to that point, they will be responsible for all of the arrears that have accrued – putting them at risk of losing their homes in the middle of winter. Some members of Congress have been pushing for additional funding to assist tenants – and landlords – with unpaid rent, but negotiations over another relief bill remain stalled.

Republished with permission under license from The Conversation.

Elderly, Health, Mass Incarceration, Uncategorized

Prisoners in US suffering dementia may hit 200,000 within the next decade – many won’t even know why they are behind bars

June 28, 2020 MuniCourts

by Rachel Lopez, Drexel University

Prison officials are bracing for a silver tsunami that will flood correctional facilities with elderly and often vulnerable prisoners.

Like the rest of the United States population, the prison population is aging fast. The U.S. Census Bureau projects that by 2030, people over the age of 55 will account for almost one-third of all incarcerated people. That means that American prisons will house upward of 400,000 older prisoners, about the same population of New Orleans, representing a near doubling of the number of older prisoners currently behind bars.

Caring for these elderly prisoners suffering from physical and mental frailty will create significant challenges for prisons.

As an expert in human rights law and a former commissioner on Pennsylvania’s Sentencing Commission, I am concerned about the burden this places on already overstretched prisons, but also the cost to human dignity. Furthermore, my research suggests that indefinitely detaining someone who does not understand why may violate the United States Constitution’s prohibition on cruel and unusual punishment.

An inmate at California Men’s Colony prison. Andrew Burton/Getty Images

Dying behind bars

America’s large aging U.S. prison population is the direct result of the “tough on crime” policies of the 1980s and 1990s, when three-strike laws and mandatory life sentences without the possibility of parole condemned many to die behind bars.

The Federal Bureau of Prisons spends approximately US$881 million per year caring for the elderly in their custody. My home state of Pennsylvania spends $3.2 million on medication for this population each month.

An 82-year-old prisoner being assisted on the breakfast line at California Men’s Colony prison. Andrew Burton/Getty Images

Part of what is driving this cost is the expense of caring for those with serious medical conditions, especially those with dementia. Last year, the federal government opened its first unit dedicated solely to caring for prisoners with dementia. The unit is staffed by nurses, correctional officers and other prisoners who receive special training to help them care for those with Alzheimer’s disease and dementia.

The challenge of caring for this population will only compound as it grows. If researchers’ estimates are correct, by the end of this decade around 70,341 to 211,020 of the elderly prison population will have dementia. Most will be unable to perform the regular activities of daily life and will eventually require around-the-clock nursing care.

Unusual cruelty

Finances are not the only concern regarding this elderly incarcerated population. There is also the cost to human dignity.

The Eighth Amendment of the U.S. Constitution upholds this principle by outlawing cruel and unusual punishment. To justify punishment, the Eighth Amendment requires that there be some penological purpose, such as retribution, rehabilitation or deterrence.

Recent U.S. Supreme Court cases suggest there is no such justification for indefinitely incarcerating those with dementia. In February 2019, the court in Madison v. Alabama – which centered around a prisoner who developed severe dementia after a series of strokes – held that it is unconstitutional to execute someone who cannot rationally understand their death sentence because it serves has no retributive purpose.

A prisoner in the hospice wing of California Medical Facility. Andrew Burton/Getty Images

The reasoning behind this ruling is centuries old. Dating back to the United States’ founding, those with limited mental capacity were entitled to special protections in the criminal context.

Sir William Blackstone, a renowned 18th-century English jurist whose commentaries on English common law deeply influenced the Founding Fathers of the United States, believed it was cruel and unusual to execute someone who lacked mental capacity.

As the U.S. Supreme Court would later echo, Blackstone reasoned that “furiosus solo furore punitur” – madness is its own punishment. Living with dementia can also feel like a punishment. People with dementia suffer gradual, irreversible loss of memory, judgment, daily functioning and health.

The effects of the disease are compounded by incarceration. Because of their profound impairments, people with dementia are sometimes unable to understand that they are in a prison, much less why. Elderly prisoners with dementia are also at an increased risk of victimization, sexual assault and bullying from other prisoners.

Additionally, because they struggle to understand and follow prison rules, they are also more likely to be subjected to harsh punishment while incarcerated. Some are punished with solitary confinement, which further degrades their physical and mental health.

Life and death

While Madison vs. Alabama addressed death sentences, a 2012 U.S. Supreme Court case provides precedent for the conclusion that the justices’ holding could be extended to life without the possibility of parole. In Miller v. Alabama, the court compared a life sentence to a death sentence, as it “forswears altogether the rehabilitative ideal.”

In other words, both sentences result in the condemned person having no ability to redeem themselves. While the court had suggested in previously cases that the death penalty is in a category all its own, in Miller it suggested that life sentences “share some characteristics with death sentences that are shared by no other sentences.”

Furthermore, when it comes to prisoners with dementia, life sentences cannot be justified as a deterrence. Simply put, how can someone adjust their behavior to avoid punishment, if they do not understand that the punishment is a consequence of their own bad acts?

Forcing those who cannot understand their punishment to live the remainder of their days behind bars appears to be exactly the type of excessive and cruel punishment that the Eighth Amendment was meant to protect against. As the elderly prison population balloons, society may need to reconsider the real world consequences of life without parole sentences.

In my view, the cost, both to taxpayers and to our basic human dignity, is too high.

Republished with permission under license from The Conversation.

Employment, Health

New Coronavirus sick leave law – who’s eligible, who’s not and how many weeks do you get

March 21, 2020 MuniCourts

by Elizabeth C. Tippett, University of Oregon

On March 18, President Donald Trump signed the Families First Coronavirus Response Act into law.

The legislation is an emergency intervention to provide paid leave and other support to millions of workers sidelined by school closures, quarantines and caregiving.

An obvious question you’re probably wondering is, “How will it affect me?”

The bad news is that the law does not provide blanket coverage for all workers. Instead, it’s a confusing mess – legislative Swiss cheese, full of exceptions and gradations that affect whether you are covered, for how long and how much pay you can expect to receive.

With schools closed, parents such as Jennifer Green, left, and Lisa Spalding, right, must stay at home with their children. Suzanne Kreiter/The Boston Globe via Getty Images

I study employment law and have combed through the bill to make sense of it. The law also provides emergency funding for unemployment insurance and subsidizes some employer health care premiums, but my focus here is on the core elements pertaining to sick and family leave.

Here’s what I learned.

Small, medium or large

To figure out whether you are covered, the first thing you’ll need to answer is how many people work at your company.

If your employer has 500 or more workers, it is excluded from the new law. Instead, workers at those companies will need to rely on any remaining sick leave benefits available under company policy or state law.

Several states, including New York, California and Washington, are also considering emergency legislation tied to the coronavirus pandemic and may offer some relief for workers at these bigger companies. These workers can also make use of the 1993 Family and Medical Leave Act, which provides for unpaid leave if the employee or a family member falls seriously ill.

In addition, some large employers have made new accommodations for their workers. Walmart, the nation’s largest employer, for example, has extended its sick leave benefits for hourly workers. And coffee chain Starbucks expanded its existing sick leave policy to provide paid leave of up to 26 weeks if an employee contracts COVID-19 and is unable to return to work.

If your company employs fewer than 500 people, you should be covered by the new law. But there’s another exception: Businesses with fewer than 50 employees can make use of a hardship exemption if providing leave might put them out of business.

School closures

Assuming your company is covered, the amount of leave available – and how much workers can expect to get paid – will depend on the reason you aren’t able to report to work or do your job remotely.

Here’s where it gets really complicated.

If you are stuck at home due to the closure of a child’s school or day care, you will be eligible for leave under two separate parts of the new law – paid sick leave and family and medical leave.

Congress seems to have structured the law to allow working parents sidelined by a school closure to use both forms of leave at once. Parents would request up to 12 weeks of leave as family and medical leave for a school closure. But since this part of the law doesn’t offer pay until the third week, parents could use the new sick leave provisions to receive income for the first two weeks.

Whether you’re using sick or family leave, you can expect to receive two-thirds of your usual pay, or up to US$200 per day. The money would come directly from your employer who will be reimbursed by tax credits.

Alternatively, people could use the sick leave for the first two weeks and then take 12 weeks under family leave, for a total of 14 weeks, but that would include two weeks that are unpaid.

If you have any available vacation or sick pay under your company’s policy, you may want to use that first since it typically provides full pay.

What happens if you get sick

Workers who are directly affected by the new coronavirus can expect more generous income replacement – but only briefly.

If you are under government-ordered quarantine or isolation, self-isolating at the instruction of a health care provider or experiencing COVID-19 symptoms and seeking a medical diagnosis, you can make use of the new federal sick leave law for up to two weeks. During this time, you should receive your usual pay, capped at $511 per day.

If you become seriously ill beyond two weeks, the new law does not offer additional paid leave. However, you may be eligible to take another 12 weeks of unpaid leave under the 1993 Family and Medical Leave Act. This covers only companies with more than 50 people and workers employed there for longer than 12 months. During this time, your job is protected, but you may be required to use any accrued sick leave or vacation available under company policy.

The rules are similar if you are caring for someone who is under government-ordered quarantine or isolation or has been ordered to self-isolate by a health care provider. The only difference is that your income would be only two-thirds of your usual pay, capped at $200 a day, for two weeks.

And again, if you are caring for a family member who becomes seriously ill, you may be able to take up to 12 weeks of unpaid leave under the 1993 act without losing your job.

In normal times, legislation like this would have been considered broad and ambitious, but as the crisis deepens, its exclusions will likely leave vulnerable workers exposed. With another stimulus bill in the works, Congress will have another chance to help Americans whose lives have been turned upside down by this pandemic.

Republished with permission under license from The Conversation.

Civil Rights, Health

Coronavirus quarantines and your legal rights: 4 questions answered

March 18, 2020 MuniCourts

by Latisha Nixon-Jones, University of Oregon

The unknown is frightening. And with the spread of a deadly and communicable disease – the coronavirus is both – individual liberties may be temporarily sidelined to protect the larger community.

Indeed, history has shown us that whenever the United States has encountered a biological threat, the government invariably weighs individual freedoms against the compelling need to protect the rest of us from a widespread epidemic. More often than not, a clampdown on civil liberties occurs.

As a disaster law scholar, I study vulnerable populations during various stages of disaster response. In the age of coronavirus, people are asking me questions about their rights. Here are some answers.

1. I had contact with someone who has the coronavirus. Am I required to go into quarantine or isolation?

The answer: It depends. The Constitution gives states the power to police citizens for the health, safety and welfare of those within its borders. This means states have the right to quarantine an individual, community or area to protect the surrounding community. With testing supplies in limited quantity and high demand, citizens are strongly encouraged to self-isolate. However, if you are a citizen who came into contact with a person with the coronavirus in a different country and then flew home, CDC officials at the airport have the right to detain you and force you into quarantine.

That said, quarantine and isolation laws vary widely, as do the consequences of breaking them.

In some states – including California, Florida and Louisiana – breaking an order of quarantine or isolation can result in misdemeanor criminal charges. Jail time could be up to a year, along with penalties ranging from US$50 to $1,000.

Those under quarantine can have visitors, but physical interaction may be limited to prevent the spread of the disease. Limitations, depending on your state or local regulation, can include confining you to a specific physical space and barring physical touching, including hugging and kissing.

Quarantined individuals do have the right to challenge the quarantine order.

You can find a list of state laws about quarantine and isolation on the National Conference of State Legislatures website.

Federal, state and local governments have the power to enforce quarantines.

2. Who can enforce quarantines?

All three levels of government have the power to quarantine.

States can quarantine citizens who present with symptoms within their borders. Local governments can quarantine smaller communities or areas of individuals that present with the coronavirus symptoms. The federal government too has responsibilities; it has the power to prevent the entry and spread of communicable diseases from foreign countries.

And the Centers for Disease Control and Prevention has the authority to detain and examine anyone arriving in the U.S. suspected of carrying the coronavirus. That includes passengers from airplanes, motor vehicles or ships.

The CDC can also issue a federal isolation or quarantine order, which allows state public health authorities to seek help from local law enforcement to administer and enforce the federal quarantine orders.

3. Under what circumstances can I be tested for coronavirus?

At this time, no legislation has been passed to create a legal right to testing.

You must contact your doctor to get approval to be tested. If you don’t have a doctor, contact your public health authority. Currently not everyone can be tested due to the shortage of tests.

The CDC website bases testing criteria on the following ailments: You have a fever; you develop virus symptoms; you recently traveled to an area with an ongoing spread of the virus; or you have been in contact with someone known to have the coronavirus.

But with the current shortage of tests, you still may not be able to be tested. As testing becomes available, the restrictions on testing may also change.

4. My state has declared a state of emergency; will that affect my rights?

According to the National Governors Association, as of March 17, “State emergency/public health emergency declarations have been issued for each state and territory, as well as the District of Columbia.”

A state of emergency allows a state to activate its emergency or disaster plan, along with the accompanying resources. It also allows states to help with local response efforts, including providing money for personnel and supplies.

The state of emergency can affect your rights because states have used emergency declarations to close or restrict the hours of private businesses, close schools and public buildings, and enforce curfews for citizens.

There are federal-, state- and local-level declarations of emergency.

The power to declare a federal state of emergency is given to the president under the Stafford Act and the National Emergencies Act.

In Oregon, the governor used its state of emergency, according to the Associated Press, to activate “reserves of volunteer emergency health care personnel, especially important in rural areas,” develop guidelines for private businesses and aid employees by defining the coronavirus as a valid cause for sick leave. The addition of the sick leave definition will allow employees to take leave to care for their own sickness or for an immediate family member.

Republished with permission under license from The Conversation.

Health, Race

Black kids and suicide: Why are rates so high, and so ignored?

January 17, 2020 MuniCourts

by Rheeda Walker, University of Houston

Teen suicide rates among black youth are increasing. In 2016 and again in 2018, national data revealed that among children age 5-11, black children had the highest rate of death by suicide. For the years 2008 to 2012, 59 black youth died by suicide, up from 54 in the years 2003-2007.

Black youth may be less likely to share their thoughts of loneliness or depression than other youth, which could be a reason for higher rates of death by suicide among black youth. Motortion Films/Shutterstock.com

Also, the 2015 Centers for Disease Control and Prevention’s biennial Youth Risk Behavior Survey reported that, compared to non-Hispanic white boys, black high-school age boys are more likely to have made serious suicide attempts that require medical attention.

I am a professor of psychology and also director of the culture, risk and resilience research laboratory at the University of Houston, and I recently co-authored a study that suggests that new risk profiles may be needed for better suicide prediction in African Americans in particular.

Comprehensive suicide awareness

Suicide has become a leading cause of death in the U.S. among all age groups, but particularly in youth and young adults. It is the second leading cause of death among 10- to 34-year-olds. Parents, teachers and professionals must be able to both talk about it and understand the risks for vulnerable children of any race. But those of us who work with black youth may also need to address some myths about suicide in the African American community.

For example, one such myth has its start almost three decades ago, Kevin Early and Ronald Akers’ interviews with African American pastors concluded that suicide is a “white thing” and that black people are accustomed to struggling through life challenges without succumbing to suicide. those authors concluded that black people see suicide as a “white thing” but it is a myth that black people do not die by suicide.

Based on anecdotal conversations that many others and I have heard in day-to-day conversations and that sometimes emerge in popular media, this opinion about suicide in the black community has shifted relatively little.

More importantly, black youth at risk may even be more difficult to identify than non-black youth. One study referred to college age racial/ethnic minority people, including African Americans, as “hidden ideators” who are less likely than other youth to disclose thoughts of suicide. Because suicide is occurring and at shockingly young ages, comprehensive efforts are needed to address this public health problem.

Studies suggest that stigma about mental illness and the feeling that one will be outcast further or ignored may keep black youth from sharing their thoughts. Also, public health and mental health experts may be unaware that suicide risk factors could show up differently depending on ethnic group.

Simply put, a one-size-fits-all approach does not work for identifying suicide risk. And little or no action has been taken to address the increasing crisis. As an African American psychologist, I find this frustrating when children’s lives are lost – lives that could be saved.

African American youth face challenges that non-Hispanic white youth may not.

Unique needs in African American mental health

Most mental health services are not designed with cultural and social nuances in mind. My research team has found consistently that the challenges that black kids face in navigating dual cultural contexts may increase their risk of suicidal thoughts.

In research on adults, we found that black men and women who used more Eurocentric or individualist approaches that was more self-focused rather than managing stress via the belief in a Higher Power were more likely to consider suicide. This was not true for those who used more culturally meaningful, spiritual coping.

When there are cultural differences, therapists must be willing to “think outside of the box” to fully evaluate risk for suicide. As an example, the racism that black Americans encounter increases stress for many. Thus, their stressors and mental health issues will need different solutions and approaches than treatments that work for white people.

In another study published in Comprehensive Psychiatry, we observed different patterns of risk for black adults compared to white adults who were admitted for psychiatric care. We examined sleep-related problems, which are elevated among black Americans, and suicide because sleep issues are a serious but understudied risk factor for suicide crisis. It turns out that inadequate sleep can escalate an emotional crisis. Our research found that problems staying awake for activities such as driving or engaging in social activities, which reveal inadequate sleep, were associated with a four-fold greater risk for suicide crisis compared to non-suicide crisis in black adults who were admitted for psychiatric treatment.

We have also found that experiencing racism is associated with thoughts about suicide for black youth and adults.

A caring, loving adult in a child’s life is essential. It is also important not to downplay a child’s feelings, telling her to cheer up or get over it. fizkes/Shutterstock.com

How to find help

Caring adults are a child’s first line of defense. If a child discloses that he is thinking about dying, it is important to ask him to share more about his ideas and if he knows he might die. If a child has a suicide plan, it is time to get professional help. The Crisis Text Line at 741741 could be an option for teens who need help to cool down in a crisis.

When it comes to finding a mental health professional, parents need an expansive list of referral options, including university-affiliated mental health clinics that offer evidence-based services on a sliding scale and federally qualified health centers for the uninsured. Regardless of the setting, a well-trained therapist may be of a different race.

Parents and caregivers must be willing to sit, listen and try to fully understand what is most upsetting for a child who is experiencing a difficult situation and a lot of emotions.

For those who believe that the alarming statistics will eventually reverse course without any action, this may be true. In the meantime, saving one life is worth the effort.

Thoughts of suicide do not mean that a child or teen needs to be hospitalized. It means they are in emotional pain and want the pain to end. Adults can investigate the problem and remove it or help the child deal with it. Online resources such as Stopbullying.gov include interactive videos that are useful to parents, educators and youth. Suggesting to a child that she “get over it” is less than helpful. A child who is already in a vulnerable state cannot problem-solve without meaningful support from the caring adults in charge.

Republished with permission under license from The Conversation.

Drugs, Health

Over 700 Doctors Who Were Paid More Than a Million Dollars by Drug and Medical Device Companies

October 24, 2019 MuniCourts

Back in 2013, ProPublica detailed what seemed a stunning development in the pharmaceutical industry’s drive to win the prescription pads of the nation’s doctors: In just four years, one doctor had earned $1 million giving promotional talks and consulting for drug companies; 21 others had made more than $500,000.

Six years later — despite often damning scrutiny from prosecutors and academics — such high earnings have become commonplace.

More than 2,500 physicians have received at least half a million dollars apiece from drugmakers and medical device companies in the past five years alone, a new ProPublica analysis of payment data shows. And that doesn’t include money for research or royalties from inventions.

More than 700 of those doctors received at least $1 million.

“Holy smokes,” said Dr. Walid Gellad, an associate professor of medicine and health policy at the University of Pittsburgh, where he leads the Center for Pharmaceutical Policy and Prescribing. It is “quite striking” how much money doctors were earning from “other activities aside from patient care,” he said.

To identify the latest pharma millionaires and other spending trends, ProPublica analyzed more than 56 million payments made from 2014 to 2018 — the first five full years of the federal Open Payments initiative, which requires companies to publicly disclose the payments as part of the 2010 Affordable Care Act.

Prescription Drugs With Top Spending on Doctor Payments

Here are the drugs for which pharmaceutical companies spent the most money paying doctors, per year, excluding research and royalty payments. The list does not include payments to teaching hospitals. Data for 2014-2016 is from a prior release of Dollars for Docs and any subsequent updates are not reflected.

Credit: Moiz Syed/ProPublica. Source: ProPublica analysis of Open Payments data from the Centers for Medicare and Medicaid Services.

Some academics and physicians predicted that the exposure might cause companies to rethink making payments and doctors to rethink taking them. A flurry of studies matched the payment data with doctors’ prescribing choices and found links between the payments and the products doctors chose.

But ProPublica’s new analysis shows that the public reporting has not dampened the enthusiasm of the drug and medical device industry for having doctors deliver paid dinner talks and sponsored speeches or paying them to consult on products.

In fact, there has been almost no change in how much the industry is spending. Each year from 2014 to 2018, drug and medical device companies spent between $2.1 billion and $2.2 billion paying doctors for speaking and consulting, as well as on meals, travel and gifts for them. (These figures do not include research spending, but they do include royalties.)

Roughly the same number of doctors — more than 600,000 — received payments in any given year.

That consistency, some academics say, is conspicuous.

“It makes me wonder whether patients are using this information or whether physicians are even aware this information is out there,” said Dr. Joseph Ross, a professor of medicine and public health at Yale who has studied pharmaceutical marketing. “It’s almost like it’s not happening.”

Holly Campbell, a spokeswoman for the Pharmaceutical Research and Manufacturers of America, defended company payments to doctors. “It is not necessarily a negative that the numbers have remained generally flat over the past five years,” she wrote in an email. “That statistic appears to be consistent with companies’ belief that their interactions with physicians have been and remain legitimate, even when subjected to sunshine.”

ProPublica first delved into the world of drug company promotional campaigns in 2010 when it gathered the payments made by seven companies that were required to make them public as part of settlements in whistleblower lawsuits. The payments were published in a database called Dollars for Docs, which allowed anyone to look up a doctor and see if he or she received a payment.

ProPublica updated Dollars for Docs with the latest data from the federal government on all payments.

Among their findings:

Consistency Breeds Familiarity

Over the course of five years, 1 million doctors, dentists, optometrists, chiropractors and podiatrists received at least one payment, most often a meal, from a company. Of those practitioners, more than 323,000 received at least one payment every year. About 240,000 received a payment in only one year. And the rest received payments in more than one year but in fewer than five.

For context, there are about 1.1 million doctors in the United States.

Dr. Aaron P. Mitchell, a medical oncologist and health services researcher at Memorial Sloan Kettering Cancer Center, said his research has shown that when doctors interact more consistently with a drug company they are more likely to prescribe that company’s cancer drug. The drug industry, Mitchell said, “knows that they need to cultivate relationships over more time, so that’s what they’re really trying to do. It’s not just one drug meal. It’s consistency.”

Some Drugs Are Promoted Heavily Year After Year

Of the top 20 drugs with the most annual spending on doctors from 2014 to 2018, six made the list in each of the years: Invokana to treat type 2 diabetes, the blood thinners Xarelto and Eliquis, the antipsychotic Latuda, the immunosuppressive drug Humira and the multiple sclerosis drug Aubagio. Another three drugs were on the list for four years: Victoza to treat type 2 diabetes, psoriasis treatment Otezla and the cholesterol-lowering drug Repatha. (Research funding and royalties are not included.)

Xarelto topped the list in spending for four years, totaling more than $123 million in payments from 2014 to 2018. In March, its makers, Johnson & Johnson and Bayer AG, agreed to pay $775 million to settle about 25,000 lawsuits claiming that the companies had failed to warn patients that Xarelto could cause fatal bleeding.

In statements, J&J and Bayer have said that the allegations lacked merit and that Xarelto is safe and effective. They noted that six cases that went to trial were decided in their favor.

Many drugs on the list are in categories where there is fierce competition. For example, seven of the top 20 in 2018 treat diabetes. And in most of the drug classes on the list, “there are more than one available drug — sometimes all with the same mechanism of action — indicated for the same condition selling for very high prices,” Dr. Aaron Kesselheim, a professor of medicine at Harvard Medical School, said in an email.

According to GoodRx, a drug discount website, the average cash price of a month’s supply of diabetes drugs Invokana, Jardiance and Farxiga is more than $600.

“Promotional spending is a major way that manufacturers in these situations distinguish themselves from each other — not by conducting comparative studies or by engaging in substantial price reductions,” Kesselheim said.

ProPublica and a number of researchers have examined the types of drugs that prompt the highest payments. Ross, of Yale, and a colleague published an analysis in the British Medical Journal in 2017 that found that the “top promoted drugs were less likely than top selling and top prescribed drugs to be effective, safe, affordable, novel, and represent a genuine advance in treating a disease.”

“Our findings suggest that pharmaceutical promotion should be met with healthy skepticism,” the analysis concludes.

Prosecutors Say the Payments by Some Drug Companies Are Kickbacks, Despite the Transparency of Open Payments

There is a perception among many physicians, including some in academia, that drug company payments are fairly benign — a moonlighting gig that educates other doctors about important medications. But since ProPublica began looking at physician payments, one drugmaker after another has paid tens, or even hundreds, of millions of dollars to resolve allegations of improper, or illegal, marketing tactics.

In fact, drug company whistleblowers and federal prosecutors have said explicitly that in some cases the payments were actually bribes and kickbacks. And this behavior has continued despite tools like Dollars for Docs.

Here are some recent examples:

Insys Therapeutics

Spending: In 2014, the payment data shows, Insys Therapeutics spent $7.5 million promoting Subsys, a fentanyl spray for advanced cancer pain, making it one of the drugs with the most spending that year. Through 2018, the company’s total spending on the drug had reached $17.6 million.

Prosecutors say: Insys paid doctors to speak about Subsys to other physicians during “educational lunches and dinners,” according to a Justice Department press release, from August 2012 to June 2015. The meals “were actually used as a vehicle to pay bribes and kickbacks to targeted practitioners in exchange for increased Subsys prescriptions to patients and for increased dosage of those prescriptions.”

Penalty: This June, Insys agreed to plead guilty to five counts of mail fraud, pay a $2 million fine and forfeit $28 million. It also agreed to pay $195 million to settle a separate whistleblower case. At least eight company executives have now been convicted of crimes relating to the illegal marketing of the drug. Insys has said it completely restructured its operations, hired new leaders and has filed for bankruptcy protection.
Avanir Pharmaceuticals

Spending: From 2014 to 2018, Avanir spent nearly $22 million on its drug Nuedexta, which treats pseudobulbar affect, or uncontrollable laughing or crying.

Prosecutors say: An Avanir employee reported that one doctor at a long-term care facility, who was also a paid speaker for Nuedexta, put “entire units” of patients on Nuedexta. Another doctor at the facility, which had a number of dementia patients, routinely stopped the Nuedexta, only to have the first doctor restart it, according to a Department of Justice press release.

Penalty: In September, the company agreed to pay more than $108 million to resolve criminal and civil allegations that it paid kickbacks to doctors and marketed the drug for unapproved uses, including behaviors associated with dementia. In a statement, Avanir said it fully cooperated with investigators “and engaged in extensive remedial measures. The individuals listed in the resolution agreements are no longer Avanir employees.”

Though relationships between drug companies and doctors continue, seemingly with little change, Kesselheim, of Harvard, said that the transparency “helps bring into light an area of the field that was in the shadows.

“Now we need to figure out what to do with this.”

Republished with permission under license from ProPublica.

Health, Race

Racism shortens lives and hurts health of blacks by promoting genes that lead to inflammation and illness

October 17, 2019 MuniCourts

By April Thames, University of Southern California

Negative social attitudes, such as racism and discrimination, damage the health of those who are targeted by triggering a cascade of aberrant biological responses, including abnormal gene activity. It is not surprising that reports documenting lifespan and causes of mortality have demonstrated a clear pattern: African Americans die sooner and bear a heavier burden of many diseases, including hypertension, heart disease, dementia and late-stage breast cancer.

Scientists have searched for genetic causes to health disparities between blacks and whites but have had limited success. The strongest evidence to date points to social-environmental factors such as poverty, health care inequities and racism.

Our society is plagued by racism and racial inequality which is not fully recognized by all, according to a recent study showing that many Americans overestimate our progress in fixing racial inequality. On the other hand, more Americans (65%) are aware that it has become more common for people to express racist or racially insensitive views, according to a U.S. survey.

Racism is not merely negative attitudes or treatment from one person to another. Racism has deep historical roots in American society, sustained through institutional policies and practices, whereby people of color are routinely and systematically treated differently than whites.

As an African American/white individual, I often experienced comments growing up like “You don’t sound black,” and “What are you?” that made me cringe. In college, I became intrigued by the field of psychology as it was a field that explained how prejudices, stereotyping and racism arise. My research as a clinical psychologist at USC is focused on understanding how societal factors interact with biology to create disparities in health outcomes. A recent study I co-authored showed that racism promotes genes that turn on inflammation, one of the major drivers of disease.

Less overt, but entrenched

Although racism may be less overt today than during the early 20th century, government policies and norms, unfair treatment by social institutions, stereotypes and discriminatory behaviors are sobering reminders that racism is still alive – and contribute to earlier deaths in addition to poorer quality of life.

For example, blacks are more likely than whites to receive drug testing when prescribed long-term opiates even though whites show higher rates of overdose. African Americans have shouldered the burden of racism for decades, creating a level of mistrust for societal systems, be it health care or law enforcement.

Terms such as “driving while black” illustrate how racism and discrimination have been deeply embedded in African American cultural experience. Just imagine trying to buy a home and being turned down because of your race. This is too common of an experience for African Americans. Nearly half (45%) reported experiencing discrimination when trying to find a home and in receiving health care, according to a Robert Wood Johnson survey that was developed by the Harvard T.H. Chan School of Public Health, Robert Wood Johnson Foundation and National Public Radio.

From macro to micro, the effect is widespread

Blacks’ exposure to chronic stress has often been cited as a reason for worse health outcomes.

Until recently, we scientists did not know the mechanism linking racism to health. The new study from my lab here at USC and colleagues at UCLA shows that the function of genes may explain this relationship. As it turns out, our study showed that genes that promote inflammation are expressed more often in blacks than in whites. We believe that exposure to racism is why.

We previously showed how activating racism, such as asking people to write down their race before taking an exam, in the form of stereotyping impairs brain functions such as learning and memory and problem-solving in African Americans. This may partly explain the higher rates of dementia in African Americans compared to whites.

Researchers have well documented that chronic stress alters the function of brain regions, such as the hippocampus, that are targeted in brain diseases such as Alzheimer’s disease. This work has been expanded through the field of social genomics, largely pioneered by my colleague Steve Cole at UCLA. A relatively new field called social genomics demonstrates how the function of genes – termed gene expression – is influenced by social conditions.

Genes are programmed to turn off and on in a certain manner. But those patterns of activity can shift depending on environmental exposures.

Certain marginalized groups demonstrate abnormal patterns of gene activity in genes responsible for innate immunity. Innate immunity is how the body fights off and responds to foreign pathogens. Dr. Cole named this pattern/sequence of gene activity the Conserved Transcriptional Response to Adversity. It refers to the how genes controlling innate immunity behave under positive or negative environmental conditions.

When environmental stresses like socioeconomic disadvantage or racism trigger the sympathetic nervous system, which controls our fight-or-flight responses, the behavior of our genes is altered. This leads to complex biochemical events that turn on genes, which may result in poor health outcomes.

The Conserved Transcriptional Response to Adversity profile is characterized by increased activity of genes that play a role in inflammation, and decreased activity of genes involved in protecting the body from viruses.

We found that blacks and whites differed in the pattern of which pro-inflammatory and stress signaling genes were turned on. Our findings are particularly important because chronic inflammation ages the body and causes organ damage.

As my colleagues and I pulled this study together, we took into consideration the health disparities such as socioeconomic status, social stress, and health care access. For example, we recruited African Americans and whites with similar socioeconomic status. We also examined racial differences in reports of other types of stress events. Both groups reported similar levels of social stress.

For this particular study, none of these traditional factors explained why African Americans had greater expression in pro-inflammatory genes than whites. However, we found that experiences with racism and discrimination accounted for more than 50% of the black/white difference in the activity of genes that increase inflammation.

So what do these results mean for future health? I believe racism and discrimination should be treated as a health risk factor – just like smoking. It is toxic to health by damaging the natural defenses our bodies use to fight off infection and disease. Interventions tailored toward reducing racism-associated stress may mitigate some of its adverse effects on health. As a society we cannot afford to perpetuate health inequities by undermining or disguising the biological impact of racism.

Republished with permission under license from The Conversation.

“You Better Push”

Bonded by Sorrow

Reggie Never Cried

His Finest Outfit

The big idea

Why it matters

How we do the work

What’s next

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2. Who qualifies?

3. What authority does the CDC have to do this?

4. What does it mean for landlords?

5. How will it be enforced?

6. What happens when the order expires?

Dying behind bars

Unusual cruelty

Life and death

Small, medium or large

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What happens if you get sick

1. I had contact with someone who has the coronavirus. Am I required to go into quarantine or isolation?

2. Who can enforce quarantines?

3. Under what circumstances can I be tested for coronavirus?

4. My state has declared a state of emergency; will that affect my rights?

Comprehensive suicide awareness

Unique needs in African American mental health

How to find help

Prescription Drugs With Top Spending on Doctor Payments

Consistency Breeds Familiarity

Some Drugs Are Promoted Heavily Year After Year

Prosecutors Say the Payments by Some Drug Companies Are Kickbacks, Despite the Transparency of Open Payments

Less overt, but entrenched

From macro to micro, the effect is widespread

Put the power of the law in your hands