Fred Clasen-Kelly, Author at KFF Health News https://kffhealthnews.org Wed, 09 Oct 2024 15:53:55 +0000 en-US hourly 1 https://wordpress.org/?v=6.5.5 https://kffhealthnews.org/wp-content/uploads/sites/2/2023/04/kffhealthnews-icon.png?w=32 Fred Clasen-Kelly, Author at KFF Health News https://kffhealthnews.org 32 32 161476233 A Boy’s Bicycling Death Haunts a Black Neighborhood. 35 Years Later, There’s Still No Sidewalk. https://kffhealthnews.org/news/article/dangerous-roads-black-neighborhoods-sidewalks-racial-equity-child-death-durham-north-carolina/ Tue, 08 Oct 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1923442 DURHAM, N.C. — It’s been 35 years since John Parker died after a pickup collided with the bike he was riding on Cheek Road in east Durham before school. He was 6.

His mother, Deborah Melvin-Muse, doesn’t display photos of him, the second-youngest of six children. His brother’s birthday was the day after the crash — and he hasn’t celebrated it since. An older brother carries a deep sense of guilt because he was looking after John that morning.

And Cheek Road, in a predominantly Black neighborhood, still lacks sidewalks for children to safely make their way to the local elementary school.

This, despite the years community activists and academic researchers have spent pleading with city leaders for safety improvements along the busy thoroughfare with sloping shoulders where John died. Drivers zoom along Cheek Road in the Merrick-Moore neighborhood, which connects downtown Durham to industrial sites and newer suburban developments.

Melvin-Muse moved her family out of the neighborhood after John’s death. “Now when I go down there, I look and see, you know, nothing really changed,” she said. “It still looks the same.”

Cheek Road has been “identified as needing improvements” by a local metropolitan planning board, said Erin Convery, Durham’s transportation planning manager, in an email.

“The infrastructure that exists is not well implemented,” concluded a May preliminary report produced by University of North Carolina-Chapel Hill students who collected data on speeding, noise, and air quality along Cheek Road. “Poorly marked crosswalks and inadequately positioned bus stops show a need for safety and accessibility improvements,” the report said.

Data was difficult to collect because “there were areas we didn’t want to get out of our cars because of the dangerous conditions,” said Ari Schwartz, one of the researchers.

In the 1940s, Black military veterans returning from World War II helped establish the Merrick-Moore neighborhood. Since then, residents say they have endured everything from noisy industrial trucks and speeding cars to illegal tire dumping and air pollution that threaten their health and safety.

Pedestrian deaths are highest in formerly redlined areas, neighborhoods where Black people lived because of discriminatory federal mortgage lending practices, research shows. The lack of sidewalks, damaged walkways, and roads with high speed limits are concentrated in these neighborhoods, studies show, creating a little-recognized public health crisis.

Governments invest in roads for people driving through such neighborhoods, but not in safety measures — like sidewalks, crosswalks, traffic circles, and speed bumps — that protect people living in them, researchers and advocates say.

“People will talk about vulnerable communities as if there is a problem with these communities, when in fact it is our systems and policies that have created these failings,” said Darya Minovi, a senior analyst at the Union of Concerned Scientists who studies environmental health and justice.

While the share of Black residents in Merrick-Moore has dropped in recent decades, data shows the neighborhood remains more than 80% Black or Hispanic and households there are typically less well-off than in other parts of the city.

“Local government takes money from the neighborhood but does not invest in it,” said Bonita Green, head of the Merrick-Moore Community Development Corporation and a former City Council candidate.

Green said the community group had documented more than 100 auto crashes along Cheek Road during a recent four-year span and at least three pedestrian deaths before 2020. In this fast-growing city of roughly 300,000, students at Merrick-Moore Elementary and others at a nearby high school sometimes walk along the road — where traffic is heavy, drivers are known to disregard the 25-mph speed limit, and the shoulders slope steeply.

When longtime residents like Ponsella Brown see kids walking there or hear about another accident, they remember the death of John Parker, who was in first grade.

“I just cringe,” said Brown, who worked as an administrative assistant at Merrick-Moore Elementary when John died. “Every time it comes up, it’s like really vivid in my mind.”

On the day John died, someone rushed into the office and said a child had been hit by a car on Cheek Road, recalled Brown, who said she ran to the scene.

“I remember the way his head was turned. I remember the spot of blood on his face. Like one speck of blood,” said Brown, who also works for the Merrick-Moore Community Development Corporation and is now a counselor at another school.

Traffic on Cheek Road is expected to increase as the population grows in Durham and surrounding areas, according to a separate April report from UNC graduate students. It noted that during the morning school drop-off time, many cars driving on Cheek Road don’t observe the posted speed limits.

Under an equity program meant to reverse the harm done to communities of color, Convery said, Durham officials are considering traffic-calming measures, including traffic circles, speed cushions, and high-visibility crosswalks.

“We’re open to future conversations that will help us achieve zero traffic deaths and injuries,” Convery said.

Yet a 2017 plan that prioritized more than 600 sidewalk projects based on safety, equity, and demand did not include Merrick-Moore Elementary School on Cheek Road, she said.

A strike by Durham school bus drivers this year only heightened concerns about the lack of safe walking routes for the 650 students who attend the elementary school, according to the April report.

Melvin-Muse, now 67, was at work when she got a call that John had been struck by a truck in front of their house. Before she left home that late May morning in 1989, she put her older kids in charge of the younger ones. They passed the time before school riding bicycles near their house, a few blocks from Merrick-Moore Elementary School, when the accident occurred.

John died two months shy of his 7th birthday from “massive head injuries,” according to The (Raleigh) News & Observer, which wrote about his death on Cheek Road at the time. John was buried in Markham Memorial Gardens, according to his obituary in The (Durham) Herald-Sun.

Melvin-Muse said his death sent the family into a tailspin of grief, anger, and regret.

“It caused a big rip in the family,” Melvin-Muse said.

Melvin-Muse and John’s father later divorced. She said she paid for therapy for her other kids, but they still got in trouble at school and two of her children ended up living in a home for kids with behavioral health issues. “It was just a bad time,” she said.

Years after the accident, Melvin-Muse said, she worked up the courage to call the driver who had hit her son. When he answered, he didn’t recognize her name, or John’s, fueling her rage, she recalled.

“I wanted revenge. An eye-for-an-eye kind of thing,” she said. “And I plotted to take him out the same way my son was taken out.”

She went so far as to get a job where he worked, the Durham County tax department, only to find he had left a week before she started.

“God knows what was in my heart and what I planned on doing,” Melvin-Muse said. “God moved him out of that place before I got there.”

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]]> 1923442 A Teen’s Murder, Mold in the Walls: Unfulfilled Promises Haunt Public Housing https://kffhealthnews.org/news/article/public-housing-unhealthy-conditions-yamacraw-village-georgia-hud-funding-backlog/ Thu, 22 Aug 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1892755 SAVANNAH, Ga. — Blocks from where tourists stroll along the cobblestoned riverfront in this racially divided city, Detraya Gilliard made her way down the dark, ruptured sidewalks of Yamacraw Village, looking for her missing 15-year-old daughter.

Like most other people living in one of the nation’s oldest public housing projects, Gilliard endured the boarded-up buildings and mold-filled apartments because it was the only place she could afford.

Without working streetlights in parts of Yamacraw, Gilliard relied on the crescent moon’s glow to search for her daughter Desaray in May 2022. She passed yards dotted with clotheslines and power lines, and a broken-down playground littered with juice boxes and red Solo cups.

“I happened to look down, and I knew it was her by her feet, by the shoes she had on,” Gilliard said. She was “barely hanging on and she was covered in blood.”

The year before Desaray died, President Joe Biden called for the federal government to spend tens of billions of dollars to fix dilapidated public housing that he said posed “critical life-safety concerns.” The repairs, Biden said, would mostly help people of color, single mothers like Gilliard who work in low-income jobs, and people with disabilities.

The federal Department of Housing and Urban Development estimates that $115 billion is needed to fund a backlog of public housing repairs. But, two years ago, money to fund those repairs became a casualty of negotiations between the Biden administration and congressional lawmakers over the Inflation Reduction Act. Republicans also have blocked efforts to lift 25-year-old legislation that effectively prohibits the construction of additional public housing, despite the catastrophic public health consequences.

Tenants living in derelict housing face conditions that contribute to higher rates of heart disease, diabetes, asthma, violence, and other life-threatening risks.

The federal government has a long history of discriminatory practices in public housing. In cities across the country after World War II, Black families were barred from many public housing complexes even as the government induced white people to leave them by offering single-family homes in the suburbs subsidized by the Federal Housing Administration. Starting with the Nixon administration, lawmakers slowed investing in new public housing as more Black families and other people of color became tenants.

Today “residents are facing really terrible choices, or terrible options about their future,” said Sarah Saadian, senior vice president of policy for the National Low Income Housing Coalition. “We got here from Congress really failing to live up to its responsibilities of ensuring that people have access to an affordable, stable home.”

In 2022, an art deco luxury apartment building opened down the street. But little has changed in Yamacraw, which is filled with Black families.

Current and former tenants say the Housing Authority of Savannah, the agency that oversees Yamacraw, has ignored the mold, rats, and roaches that infest the units and sicken residents, and the bullet holes in windows and gunshots that ring through the night. Now they fear the city is using the poor state of Yamacraw as justification to push residents out.

In April, an inspection of Yamacraw apartments conducted by HUD, which oversees taxpayer-supported public housing nationwide, found 29 “life-threatening” deficiencies that pose a high risk of death to residents, according to a preliminary report.

The inspection cited 28 deficiencies it called “severe,” meaning they present a high risk of permanent disability, serious injury, or illness. An additional 195 deficiencies were cited as “moderate” because they could cause temporary harm or prompt a visit to a doctor.

Research links structural racism and disinvestment to chronic gun violence, which has taken a heavy toll on Black neighborhoods and kids such as Desaray. A study of gun injuries in four large cities at the height of the covid-19 pandemic found that Black children were 100 times as likely as white youths to suffer a firearm assault.

Study co-author Jonathan Jay, an assistant professor of community health sciences at Boston University, said most of the country’s gun violence stems from disputes in neighborhoods that lack investment in housing and other public services

“This is about white privilege,” Jay said. “The result is driven by racist policymaking.”

Desaray Gilliard was a high school freshman when she was killed. She loved clothes, music, dancing, and the color pink, her mother said. She planned to go to Italy with her art class. She was excited about learning to drive and getting a job. Desaray had her sights set on attending Ohio State University.

They’d lived in Yamacraw for seven years. The teen’s shooting death remains unsolved.

Gilliard has struggled with thoughts of self-harm, she said. She maintains a memorial with pictures, stuffed animals, and flowers near the spot where she found Desaray’s body.

“I have to remember this is for her,” she said of her middle child’s death, “because nobody else is doing these things for her to keep her memory alive.”

A Broken Promise?

Federally funded public housing must be kept in “decent, safe and sanitary” condition, according to HUD. In 2013, the agency’s then secretary, Shaun Donovan, visited Savannah to announce a program that could give the local housing authority millions of dollars to rehab four public housing complexes, including Yamacraw, which has been among the lowest-rated public housing complexes in Georgia.

The Rental Assistance Demonstration program touted by Donovan did not provide new public money. Instead, it loosened rules to allow local officials to work with private lenders and developers to pay for repairs, transforming public housing complexes into mixed-income developments with Section 8 project-based rental assistance.

Last year, a consultants’ report found a host of problems in Yamacraw, including water leaks and faulty wiring. “The Remaining Useful Life of the Property is estimated to be 0 years,” the consultants wrote. The housing authority wants to demolish Yamacraw and replace it with homes that are “healthier, more energy efficient and accessible,” the report said.

Yamacraw never saw the windfall Donovan promised, current and former tenants said. Even with a housing assistance waitlist of more than 3,000 families in Savannah, records show most of the 315 apartments in Yamacraw sit empty, many with boarded-up doors and windows. Some other public housing developments in the area have been repaired or rebuilt, but except for new roofing added in 2019, Yamacraw has not had a significant renovation in years, according to the consultants’ report.

Rather than repair the units, local officials started a process to tear down the complex, threatening to displace residents who have nowhere else to go in a city where the average two-bedroom apartment rents for more than $1,600 monthly.

Congress has provided less money than was needed over the past 20 years to fix Yamacraw and other public housing complexes nationwide, leaving local agencies in a tough spot, said Earline Davis, executive director of the Housing Authority of Savannah.

The housing authority still plans to demolish Yamacraw and redevelop the property with new affordable housing, she said. Residents fear that they will be pushed out, and that because of its prime location, the redevelopment plans would prioritize apartments that attract people who can afford higher rents.

“Anytime you want to do something to make money — go destroy the historic Black community,” said Georgia Benton, who grew up in Yamacraw. “But ain’t nobody hollerin’ ‘Stop.’”

She and her son LaRay Benton have been fighting the housing authority’s redevelopment plans, which they say could also disrupt the two-century-old First Bryan Baptist Church. Rev. Andrew Bryan, a former enslaved person and ordained minister, founded the church in 1788. He later bought his freedom.

The Bentons and three City Council members went door to door observing the condition of residents’ units. They said plumbing issues caused sewage overflows and leaky faucets, mold tracked across the ceilings, and there were insect and rodent infestations.

Many families said they developed respiratory problems, such as bronchitis and asthma, after they moved in. “It is an unhealthy situation,” LaRay Benton said.

About seven years ago, after his previous Savannah landlord raised the rent, Paris Snead, his wife, and two children found themselves homeless. A nonprofit helped them get into Yamacraw, where rent was $750 a month.

It’s been years since they left. Snead said he still takes a daily allergy pill because he believes he was exposed to mold in his unit, which caused allergy-like symptoms.

“The walls sweat like working men,” Snead said of his former apartment. “The walls will, literally, from the top to the bottom, leak water.”

“When you’re homeless, and you want to be able to have a place for your kids, I mean, you’ll make a home wherever you can,” he said.

Snead said he showed Yamacraw’s management the leaking walls, but they didn’t act.

“The management team there did more to evict people and cause problems than they did to help families and ensure they had a place to stay,” Snead said.

HUD, which conducts periodic inspections at public housing complexes, declined an interview request. The agency referred questions to the Housing Authority of Savannah.

The housing authority’s redevelopment plans have been delayed by HUD’s lengthy approval process, said Savannah Mayor Van R. Johnson II, who appoints people to a five-member board of commissioners that helps oversee the city’s public housing.

He said he met with HUD acting Secretary Adrianne Todman and other HUD officials about housing issues in Savannah.

“People don’t deserve to live like that,” Johnson said.

If Yamacraw is demolished and rebuilt, he said, current tenants will have a chance to return because the homes will be affordable to people with low incomes.

Nobody else is doing these things for her to keep her memory alive.

Detraya Gilliard

‘The Worst Experience of My Life’

Yamacraw’s struggles are rooted in century-old policies that have made it difficult for many Black neighborhoods to thrive.

In the 1930s, the federal government’s Home Owners’ Loan Corp. made color-coded maps for Savannah and 238 other cities and labeled redlined areas — usually places where Black people, Jews, immigrants, and Catholics lived — as undesirable for investment.

“The houses are occupied by the lowest class negro tenants,” a government surveyor wrote.

Yamacraw was opened in 1941 as segregated public housing for Black people. Today a health clinic occupies the original administrative building, designed to look like a plantation house.

Despite its problems, Johnson said, some of the city’s most prominent doctors, lawyers, and ministers grew up in Yamacraw.

Former and current tenants said the apartments slowly descended into disrepair.

Each year more than 10,000 public housing apartments across the U.S. become uninhabitable.

Some lawmakers have used the poor state of public housing as justification to refuse lifting a moratorium passed during the Clinton administration that prohibits the construction of additional units, even as the nation’s rental prices — and evictions — soar.

The argument that public housing “doesn’t work” is disingenuous, said Saadian, with the National Low Income Housing Coalition.

“The federal government really failed to invest in public housing, to keep it in good condition, and to keep those communities thriving,” Saadian said, “and in many cases, actively contributed to those communities declining.”

Instead of repairing public housing and building more high-quality units, federal lawmakers promised to provide housing vouchers, commonly known as Section 8, which helps people with low incomes rent privately owned homes. But most people who qualify for vouchers never receive them. Those who do often struggle to find landlords who will accept them, rendering them sometimes worthless.

Three years ago, LaTonya Atterbury was living in hotels north of Atlanta when she was offered a unit in Yamacraw for $511 a month. In August 2021, she moved in with her niece, now 29, and her niece’s son, now 8, relieved to have more stable housing.

But within the first week, she said, a neighbor’s son broke her window and the housing authority charged her $60 to fix it. She said her bathroom is covered in mold and mildew. One day, months after she moved in, Atterbury noticed a hole in her second-story window and saw a bullet on the floor, and realized there had been a shooting overnight. No one was injured, she said, but the bullet hole was only recently fixed — about 2½ years after the incident.

“It’s been the worst experience of my life,” Atterbury said. “Sitting here will make you very depressed.”

Atterbury said she and other residents remain in Yamacraw at least in part because the housing authority has promised vouchers to move elsewhere. Three years later, she is still waiting.

Demolishing and rebuilding Yamacraw could take years.

Davis, the housing authority’s executive director, said her agency has repeatedly told tenants they would be relocated to other public housing complexes or given a Section 8 voucher during construction if they have no lease violations. But residents say they routinely receive lease violations for harmless acts such as broken blinds. LaRay Benton said one resident was cited and fined $75 for leaving a stroller on her front porch while she took her baby inside.

A Mother’s Search

Researchers said that the presence of abandoned buildings can contribute to violent crime by making people feel unsafe and creating a sense of disorder. Studies suggest that razing abandoned buildings and improving green space can reduce it.

“No gun policy is going to work if we don’t fix social infrastructure,” said Jonathan Metzl, director of the Department of Medicine, Health, and Society at Vanderbilt University. “We need investments to make sure communities feel safe. This is not just a public health problem. This is a race problem. This is a democracy problem.”

In recent years, shooting victims or their relatives, including Desaray’s mother, have filed at least three lawsuits against the Housing Authority of Savannah. Those ongoing lawsuits allege the agency failed to take added security measures in its public housing complexes — some of which had fallen into disrepair — despite gun violence and other crimes.

“I don’t know how we can prevent shootings,” Davis said.

Davis declined to comment on the lawsuits. She would say only that her agency has installed cameras in Yamacraw, worked with police, and asked residents to report crime. The actions came after Desaray’s death.

Johnson, Savannah’s mayor, said police have investigated the Desaray Gilliard case, but there are people “who know what happened” and will not talk to officers.

Around 9 p.m. on a Friday night two years ago, Gilliard went looking for her daughter for the second time that night. Desaray missed an 8 p.m. curfew and wasn’t answering her phone.

Gilliard waited for about 30 minutes at a bench near a park in the middle of the complex, hoping Desaray would find her. Then she started to retrace her steps.

Gilliard called 911 after she saw her daughter’s body.

When the police arrived, they made their way through the darkened complex with flashlights, Gilliard said. An officer pulled up Desaray’s shirt and saw a bullet hole in her chest. Gilliard said she later learned from a funeral director that her daughter had been shot three times. She has yet to receive an autopsy report from the police.

Gilliard said “nothing has changed before, since, or after” her daughter’s death.

“It’s been very difficult,” she said. “Sometimes I wanted to give up. I even thought about committing suicide.”

About a month after Desaray died, Gilliard said someone tried to break into her apartment. A couple of weeks later, her request to move to a new complex was finally granted and Gilliard left Yamacraw.

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]]> 1892755 US Surgeon General Declares Gun Violence ‘a Public Health Crisis’ https://kffhealthnews.org/news/article/gun-violence-us-surgeon-general-vivek-murthy-public-health-crisis/ Tue, 25 Jun 2024 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1872138 U.S. Surgeon General Vivek Murthy declared firearm violence a public health crisis, as gun deaths and injuries punctuate daily life in America.

On nearly every day of 2024 so far, a burst of gunfire has hit at least four people somewhere in the country. Some days, communities have endured four or five such shootings.

The nation’s top doctor called on policymakers to consider gun safety measures such as bans on assault weapons and high-capacity ammunition magazines and universal background checks for all firearm purchases. His advisory also urges a “significant increase” in funding for research on gun injuries and deaths, as well as greater access to mental health care and trauma-informed resources for people who have experienced firearm violence.

In 2022, more than 48,000 people were killed by guns in the U.S., or about 132 people a day, and suicides accounted for more than half of those deaths, according to data from the Centers for Disease Control and Prevention. An additional 200-plus Americans seek emergency care for firearm injuries each day, according to estimates from Johns Hopkins University research. No federal database records nonfatal gun injuries.

The Office of the Surgeon General does not set or carry out gun policy, but historically its reports and warnings have nudged policymakers and lawmakers to act.

Murthy, a physician, told KFF Health News he hoped to convey the broader toll of gun violence on the nation and the need for an urgent public health response. He cited soaring gun deaths among children and teens and noted that “the mental health toll of firearm violence is far more profound and pervasive than many of us recognize.”

“Every day that passes we lose more kids to gun violence,” Murthy said, “the more children who are witnessing episodes of gun violence, the more children who are shot and survive that are dealing with a lifetime of physical and mental health impacts.”

Firearm-related homicides over the past decade and suicides over the past two decades have driven the sharp rise in gun deaths, the advisory says.

Guns are the leading cause of death for children and teens, with higher death rates among Black and Hispanic youths. Researchers from Boston University found that during the height of the covid pandemic, Black children were 100 times as likely as white children to experience gun injuries. Hispanic and Asian children also saw major increases in firearm assault injuries during that time, that study showed.

Joseph Sakran, executive vice chair of surgery at John Hopkins Hospital in Baltimore and chief medical officer for Brady United Against Gun Violence, said the surgeon general’s declaration is a “historic moment that sounds the alarm for all Americans.”

But Sakran added: “It cannot stop here. We have to use this as another step in the right direction. No one wants to see more children gunned down.”

Murthy has long said gun violence should be framed as a health issue. He argued that the approach has been successful in combating significant societal problems, citing tobacco control efforts that took hold following the then-surgeon general’s landmark 1964 report concluding that smoking cigarettes causes lung cancer and other diseases.

“We saved so many lives, and that’s what we can do here, too,” Murthy said.

Murthy’s move is one of several recent Biden administration actions designed to combat gun violence, as most gun-related measures remain political nonstarters in Congress. Federal officials have allowed states to use Medicaid dollars to pay for gun violence prevention, and the White House has called on hospital executives and doctors to gather more data about gunshot injuries and to routinely counsel patients about the safe use of firearms.

While available data points to tragic outcomes across American communities, government officials and public health researchers have long been stymied by sparse federal funding devoted to gun violence research and the scope of its health effects.

“I’ve been studying gun violence for about 33 years now and there’s still some really basic and fundamental questions I can’t answer,” said Daniel Webster, a gun violence researcher at Johns Hopkins University.

“To really understand gun violence, you need to do more than just look at publicly available surveillance data,” he said. “You need to actually do in-depth studies involving the populations at highest risk for shooting or being shot.”

A Brady analysis found that of the 15 leading causes of death in the U.S., firearm injuries received the third-lowest amount of federal research funding through the National Institutes of Health for each person who died. The only causes of death that garnered less research funding through NIH were poisonings and falls, according to the analysis.

Sonali Rajan, an adjunct associate professor of epidemiology at Columbia University who researches the effects of gun violence on children, said political leaders and others need to reframe the debate on gun violence from crime to public health.

“We are raising a whole generation of children for whom exposure to gun violence is normal,” Rajan said.

In Michigan, “we had a kid survive the Oxford High School shooting only to go to Michigan State University and see another mass shooting,” she said. “It is unbelievably shameful.”

Serving as President Joe Biden’s surgeon general since 2021, Murthy has, at times, caused political controversy with his views on gun violence.

Over a decade ago, former President Barack Obama nominated Murthy to be the nation’s top doctor. But Murthy’s support for a federal ban on the sale of assault weapons and ammunition and additional restrictions on gun purchases drew the ire of the National Rifle Association, as well as Republicans and some Democrats in Congress. The U.S. Senate narrowly confirmed Murthy to the job in December 2014, more than a year after his nomination.

Murthy has previously issued advisories on social isolation and loneliness, youth mental health, and the well-being of health workers. He said gun violence comes up in many of his conversations with young people about the mental health challenges they’re facing.

“Fears around gun violence have really pervaded so much of the psyche of America in ways that are very harmful to our mental health and well-being,” Murthy said.

Many other causes of death are treated differently as to understanding the problems and developing solutions, Webster said. But “that’s generally not what we’ve done with gun violence. We’ve oversimplified it and overpoliticized it.”

As Sakran put it: “As we look at firearm injuries, there’s arguably no public issue that’s as urgent.”

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]]> 1872138 Exclusive: Social Security Chief Vows to Fix ‘Cruel-Hearted’ Overpayment Clawbacks https://kffhealthnews.org/news/article/exclusive-social-security-chief-omalley-fix-overpayment-clawbacks/ Wed, 13 Mar 2024 19:36:00 +0000 https://kffhealthnews.org/?post_type=article&p=1826488 The Social Security Administration’s new chief is promising to overhaul the agency’s system of clawing back billions of dollars it claims was wrongly sent to beneficiaries, saying it “just doesn’t seem right or fair.”

In an interview with KFF Health News, SSA Commissioner Martin O’Malley said that in the coming days he would propose changes to help people avoid crushing debts that have driven some into homelessness and caused financial hardships for the nation’s most vulnerable — the poorest of the poor and people with disabilities or persistent medical conditions or who are at least age 65.

O’Malley, who took office in December, said that “addressing the injustice we do to too many Americans because of overpayments, the rather cruel-hearted and mindless way that we recover those overpayments,” is among his top priorities.

He said he has concrete steps in mind, such as establishing a statute of limitations, shifting the burden of proof to the agency, and imposing a 10% cap on clawbacks for some beneficiaries.

“We do have the ability and we do have the authority to address many of these injustices,” he said, suggesting that the SSA won’t have to wait for congressional action.

The pledge comes after an investigation by KFF Health News and Cox Media Group television stations revealed that SSA routinely reduces or halts monthly benefit checks to reclaim billions of dollars in payments it sent to beneficiaries then later said they should not have received.

In some cases, years passed before the government discovered its mistake and then imposed debts that sometimes have reached tens of thousands of dollars on people who cannot afford to pay. KFF Health News and Cox Media Group discovered that more than 2 million people a year have been hit with overpayment demands.

Most overpayments are linked to the Supplemental Security Income program, which provides money to people with little or no income, who are disabled, blind, or at least age 65. Others are connected to the Social Security Disability Insurance program, which aids disabled workers and their dependents.

O’Malley said the agency plans to cease efforts to claw back years-old overpayments and halt the practice of terminating benefits for disabled workers who don’t respond to overpayment notices because they did not receive them or couldn’t make sense of them.

“We’re not fulfilling congressional intent by putting seniors out of their homes and having them live under a bridge when they didn’t understand our notice,” O’Malley said.

Denise Woods lives in her Chevy, seeking a safe place to sleep each night at strip malls or truck stops around Savannah, Georgia. Woods said she became homeless in 2022 after the SSA — without explanation — determined it had overpaid her and demanded she send back roughly $58,000. Woods didn’t have that amount on hand, so the agency cut off her monthly disability benefits to recoup the debt.

The agency later restored some of her benefit allowance: She gets $616 a month. That’s not enough to cover rent in Savannah, where even modest studio apartments can run $1,000 a month.

In January, she fell ill and landed in intensive care with pneumonia. “I signed a [Do Not Resuscitate form] and a nurse asked, ‘Do you know what this means?'” Woods said. “I told her there was no reason to revive me if my heart stops. They have already ruined my life. I’m beyond exhausted.”

After KFF Health News and Cox Media Group published the series “Overpayment Outrage,” hundreds of disability beneficiaries came forward with troubling accounts, including how the government sent them overpayment notices without explanation and threatened to cut off their main source of income with little warning.

Members of Congress publicly demanded that SSA fix the problems. Democratic Sen. Ron Wyden of Oregon said he would meet monthly with agency officials “until it is fixed.”

Sens. Gary Peters and Debbie Stabenow, both Michigan Democrats, sent a letter dated Feb. 29 to the SSA, saying many overpayments were caused by the agency. They asked officials to explain what is causing the problems.

“It’s absolutely critical that the agency is accurately administering these benefits,” Peters said in written response to an interview request. “I’ve heard from too many people across Michigan who have faced financial hardship after the agency sent them incorrect payments.”

The agency recovered $4.9 billion of overpayments during the 2023 fiscal year, with an additional $23 billion in overpayments still uncollected, according to its latest annual financial report.

O’Malley said he wants to address overpayment clawbacks as part of a larger effort to address SSA’s “customer service crisis.” He did not provide specifics but said he anticipated plans would be implemented this year.

Officials have long acknowledged that the federal disability system is dogged by lengthy delays and dysfunction. Some people become homeless or grow sicker while waiting for an initial decision on an application, which took an average of over seven months in 2023, according to a letter signed by dozens of members of Congress.

O’Malley said the agency terminates disability benefits for some people who don’t contact the SSA after receiving a clawback letter.

“To be honest, a lot of problems [are caused by] our notices being hard to read,” O’Malley said. “In fact, one might argue that the only thing that’s really clear about the notice is to call the 800 number.”

The agency’s toll-free number, O’Malley said, is on his fix-it list, too.

Callers complain of lengthy hold times and often are unable to reach an agent for help, according to congressional members, disability attorneys, and others.

O’Malley pointed to a 27-year low in staffing. “We’ve been unpacking many of these customer service challenges,” he said. “There’s not one of them that hasn’t been made worse by the short staff.”

Still, he said, the overpayment process is unfair. Beneficiaries often must produce evidence to show they did not receive extra money, O’Malley noted.

“One would assume that in a country where people are innocent until proven guilty,” he said, “that the burden should fall more on the agency than on the unwitting beneficiary.”

(WSB-TV, Atlanta)

Advocates for the poor and disabled said they are hopeful O’Malley will stick to his commitments.

“Overpayments have long plagued our clients and caused severe hardship,” said Jen Burdick, an attorney with Community Legal Services of Philadelphia, which represents clients who have received overpayment notices. “We are heartened to see that SSA’s new commissioner is taking a hard look at overpayment policy reforms and optimistic and hopeful his administration will provide these folks some long-needed relief.”

Mike Pistorio is worried that change won’t come fast enough for him.

A letter dated Sept. 21, 2023, that he received from the Social Security Administration says he was overpaid $9,344. The letter alleges Pistorio — a disabled 63-year-old who said he has four stents in his heart — received too much money on behalf of his children, who are now adults.

Pistorio said that he doesn’t understand why he owes the government money and that the SSA has not answered his questions. He said he and his wife live in fear of being evicted from their home because they depend on his $1,266 monthly disability benefits to pay rent.

“What makes me mad is none of this is my fault,” said Pistorio, who lives in Middletown, Pennsylvania, and worked as a plumber until his health faltered. “The stress of this has made my diabetes go up.”

Pistorio said the agency has offered to deduct $269 a month from his benefits to pay off his debt — an amount he says he cannot afford.

“I have told them ‘I will lose my housing,’” Pistorio said.

David Hilzenrath of KFF Health News and Jodie Fleischer of Cox Media Group contributed to this report.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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]]> 1826488 Advocates Say a Practice Harms Disabled Children, Yet Congressional Action Is Stalled https://kffhealthnews.org/news/article/health-202-restraint-and-seclusion-disabled-children-schools/ Fri, 02 Feb 2024 14:11:15 +0000 https://kffhealthnews.org/?p=1809207&post_type=article&preview_id=1809207 In the photos, a 9-year-old boy with autism appears barricaded between cubbies and furniture stacked near the walls of a North Carolina classroom.

His mother, Erin McGrail, said her son was physically restrained at least 14 times while in third grade at Morrisville Elementary School. She said she learned details of his seclusion only after filing a due process complaint.

“I was furious the first time I saw them,” McGrail said of the photos. Her family reached a settlement last year with the Wake County Public School System. “They never told us how this was done. We had no idea.”

No federal law prohibits schools from restraining and secluding children. So a patchwork regulatory system operates across states, with little accountability and oversight, according to parents, lawmakers and advocates for people with disabilities.

Federal data obtained by KFF Health News show that each year, thousands of children — disproportionately those with disabilities and students of color — are secluded at school, often in windowless rooms or makeshift enclosures, as happened to McGrail’s son. In some cases they are physically prevented from moving by school employees, or put in handcuffs or other mechanical restraints.

And the numbers are almost certainly an undercount. While federal law requires school districts to tell the Education Department every time they restrain or seclude a student, Wake County Public Schools reported no instances of the practices for nearly a decade, according to civil rights data the department published. The district said it reported revised data to the federal government in 2022, which came after McGrail’s son was physically restrained at Morrisville Elementary.

“It is unconscionable there are thousands of students each year who are being put in solitary confinement, pinned to the ground, or strapped to a chair as punishment for misbehavior,” Sen. Chris Murphy (D-Conn.), who has repeatedly introduced legislation to restrict the practices, said in a statement. His bills have so far found little traction in Congress.

Since at least 2009, the Government Accountability Office has warned Congress that physical restraint and seclusion can be dangerous.  In some cases, the GAO reported, children have been seriously injured or died. And nurses and pediatricians have warned the practices can escalate negative behaviors.

Catherine Lhamon, assistant secretary for the Office for Civil Rights at the Education Department, told KFF Health News that “imposing restraint on the student is traumatizing, period, and so imposing trauma on a student can exacerbate existing disabilities.”

Guy Stephens, executive director of the Alliance Against Seclusion and Restraint, a nonprofit advocacy group based in Maryland, said the legislation remains a non-starter with many Republican lawmakers.

“This bill should be an easy one to pass,” said Stephens, who said his own son was repeatedly restrained and secluded in school. “This is a human rights issue. Our rights as humans should not vary from state to state. We live in a world where more things are partisan than probably should be.”

Through a spokesperson, Sen. Bill Cassidy (La.), the senior Republican on the Senate Health, Education, Labor and Pensions Committee, declined to comment.

AASA, a national association of school superintendents, has opposed federal legislation to restrict the use of restraint and seclusion, arguing that the practices are sometimes necessary to protect other students and school staff. AASA spokesperson James Minichello declined to comment.

McGrail, who lives in Apex, N.C., said in a complaint she filed with federal officials that her son was injured at least three times while being restrained. Wake County district spokesperson Matt Dees declined to answer questions about McGrail’s allegations, citing student privacy laws.

McGrail’s son, now in fifth grade, started at a new public school in North Carolina on Jan. 10. McGrail said the school agreed to keep a data log detailing his activity. School records show that his first day began at 11:15 a.m. At 11:19, he was restrained. By 11:24 he was in the seclusion room with the door closed.

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]]> 1809207 Escuelas ignoran normas federales sobre restricción y aislamiento de estudiantes https://kffhealthnews.org/news/article/escuelas-ignoran-normas-federales-sobre-restriccion-y-aislamiento-de-estudiantes/ Wed, 17 Jan 2024 14:17:37 +0000 https://kffhealthnews.org/?post_type=article&p=1806223 En las fotos se pueden ver manchas de sangre en las paredes blancas de una pequeña sala en una escuela de Carolina del Norte, donde un niño de segundo grado se golpeó repetidamente la cara en el otoño de 2019, según su madre.

Michelle Staten dijo que su hijo, que tiene autismo y otras afecciones, reaccionó como lo harían muchos niños con discapacidades cuando lo encerraron en una sala de aislamiento en la escuela primaria Buckhorn Creek.

“Como madre, siento mucha culpa por lo que pasó”, dijo Staten, quien envió las fotografías como parte de una queja que presentó al gobierno federal en 2022. “Mi hijo quedó traumatizado”. 

Documentos indican que la restricción física y el aislamiento eran parte del plan de educación especial del Sistema de Escuelas Públicas del condado de Wake para el hijo de Staten. La madre contó que, desde 2017, cuando su hijo estaba en jardín de infantes, fue inmovilizado y obligado a permanecer aislado en repetidas ocasiones. 

La ley federal exige que los distritos escolares, como el condado de Wake, informen al Departamento de Educación de Estados Unidos cada vez que aíslan o restringen físicamente a un estudiante.

Pero durante casi una década, desde 2011, el distrito no reportó ninguno de estos incidentes, según datos suministrados al gobierno. El condado de Wake tiene uno de los distritos escolares más grandes del país, con casi 160,000 niños y más de 190 escuelas.

Staten dijo que se alarmó al enterarse de que el distrito no reportaba datos, y en marzo de 2022 envió una queja a la Oficina de Derechos Civiles del Departamento de Educación. En la carta, dijo que el distrito argumentó que estas medidas se habían establecido por la seguridad del menor, pero que en ninguna parte se documentaron los incidentes.

Esta forma de disciplina “se utiliza, a menudo con frecuencia, en formas que perjudican a los estudiantes”, dijo Catherine Lhamon, subsecretaria de la Oficina de Derechos Civiles.

El Departamento de Educación dijo que está contactando a las escuelas que no reportan estas intervenciones, utilizadas de forma desproporcionada con los estudiantes que tienen discapacidades y los niños de color, como el hijo de Staten.

Lhamon calificó estas prácticas como “una cuestión de vida o muerte” y destacó la importancia de obtener datos precisos a nivel federal. El secretario de Educación, Miguel Cardona, anunció nuevas directrices para las escuelas en 2022 y observó que “con demasiada frecuencia, los estudiantes con discapacidades están sometidos a medidas disciplinarias duras y excluyentes”.

“Niños con moretones”

Por más de una década, enfermeras escolares, pediatras, legisladores y otras personas han advertido sobre los peligros de las medidas de restricción y aislamiento, que pueden causar traumas serios y agravar los comportamientos negativos en los niños. En los peores casos, se han reportado lesiones graves y muertes.

“En un mundo perfecto, estarían prohibidas”, dijo Stacey Gahagan, abogada experta en derechos civiles que ha representado a familias en casos de aislamiento y restricción. Estas intervenciones “se utilizan de forma inadecuada”, explicó. “Veo niños que tienen miedo de ir a la escuela y padres con fotos de sus hijos golpeados”.

No hay una ley federal que las prohíba. Esto ha generado un sistema disfuncional, con poca supervisión y rendición de cuentas en los distintos estados y distritos escolares, según padres y grupos que abogan por los derechos de las personas con discapacidades.

Cada año el gobierno federal recibe decenas de miles de denuncias de casos de restricción física y aislamiento. Pero es probable que haya más, dicen padres y defensores de estudiantes, ya que el relevamiento de datos depende de los administradores de las escuelas, que no siempre aportan la información.

Es un problema que hasta el Departamento de Educación reconoce.

El Sistema de Escuelas Públicas del condado de Wake declinó responder a preguntas sobre el caso de Staten para este artículo, citando leyes de privacidad estudiantil.

Un informe de 2022 presentado al Congreso indicó que las escuelas de Carolina del Norte tenían la tasa más alta de expulsiones y suspensiones de estudiantes con discapacidades de todo el país.

Ese año, el distrito presentó al gobierno federal datos revisados sobre el uso de restricción y aislamiento durante el año escolar 2015-16, dijo Matt Dees, vocero del Sistema de Escuelas Públicas del condado de Wake, donde estaba matriculado el hijo de Staten. En una declaración escrita, dijo que las reglas federales sobre el proceso de relevamiento de datos habían sido confusas. “Hay distintos requerimientos estatales y federales, lo cual contribuyó a problemas con los datos”, dijo Dees.

Pero padres y defensores de niños con discapacidades no están convencidos. “Esa explicación sería verosímil si hubieran reportado por lo menos alguno”, dijo Gahagan. “Pero durante años no reportaron ninguno, en el distrito escolar más grande de nuestro estado”.

Hannah Russell forma parte de una red de padres y defensores en Carolina del Norte que ayudan a familias a navegar el sistema escolar. Dijo que incluso cuando los padres presentan fotos de sus hijos con heridas, les dirán que “eso no ocurrió”.

En Carolina del Norte, el 91% de los distritos no reportaron ningún incidente de restricción y aislamiento en el año académico 2015-16, el segundo porcentaje más alto del país después de Hawaii, según un informe federal.

“Esto ya era un problema antes de covid”, dijo Russell, que fue maestra de educación especial y cuyo hijo con necesidades especiales fue restringido y aislado en la escuela. “Pero ahora es un problema inmenso”.

El Departamento de Instrucción Pública de Carolina del Norte, que está a cargo de supervisar las escuelas públicas del estado, no ofreció entrevistas con sus funcionarios ni respondió a preguntas escritas.

En un correo electrónico, la vocera Jeanie McDowell solo dijo que las escuelas reciben capacitación para informar sobre estas medidas disciplinarias.

Por lo general, a los docentes se les permite utilizar tácticas de restricción y aislamiento solo para proteger a los estudiantes u otras personas en caso de peligro inminente. Pero los críticos de estas prácticas señalan casos en los cuales niños han muerto o han sufrido trastornos de estrés postraumático y otras lesiones por faltas menores, como no quedarse sentados o “no cooperar”.

Cero casos reportados

En 2019, la Oficina de Responsabilidad Gubernamental (GAO, por sus siglas en inglés), que realiza investigaciones para el Congreso, dijo que alrededor del 70% de los distritos escolares de país no reportan ningún incidente.

Según un informe de GAO de 2020, el Departamento de Educación tiene “procesos de control de calidad ineficaces o inexistentes para los datos suministrados por los distritos escolares públicos sobre incidentes de restricción y aislamiento”.

Lhamon dijo que su oficina está realizando investigaciones en todo el país y pidiendo a los distritos que corrijan los datos equivocados. El Departamento de Educación quiere que los distritos escolares cumplan voluntariamente con la ley federal de derechos civiles que protege a los estudiantes con discapacidades. Si no lo hacen, los funcionarios pueden revocar la asistencia financiera federal a los distritos o remitir los casos al Departamento de Justicia.

El año pasado, el Sistema de Escuelas Públicas del condado de Wake resolvió una demanda que surgió porque el distrito no reportó ningún incidente de restricción o aislamiento en el año escolar 2017-18, a pesar de que un estudiante fue sometido a estas prácticas, y fue testigo de su uso en otros niños, según Gahagan, quien representó a la familia del estudiante.

Como parte del acuerdo extrajudicial, el distrito acordó notificar a los padres si sus hijos habían sido restringidos o aislados al final de cada día escolar.

Gahagan dijo que el sistema sería más transparente en el condado de Wake, pero que los problemas persisten en el resto del país. Las escuelas a veces ocultan los incidentes de aislamiento a los padres, usando términos como “penitencia”, o “time-out”, entre otros eufemismos, expresó.

“Para la mayoría de los padres, un ‘time-out’ no significa encerrar a un niño en un armario”, dijo Gahagan. “¿Qué recursos tienen los padres? No hay muchos controles. No hay suficiente responsabilidad”.

Aún así, Gahagan, quien fue maestra, se solidarizó con los docentes. Las escuelas no pueden pagar consejeros ni programas de capacitación para capacitar a maestros, directores y otros empleados sobre las técnicas necesarias para manejar situaciones tensas, lo cual ayudaría a reducir la dependencia de las intervenciones físicas, explicó.

Jessica Ryan dijo que en la ciudad de Nueva York, su hijo, que tiene autismo, recibía apoyo y terapia ocupacional y tenía un aula con maestros de educación estándar y de educación especial. Pero cuando la familia se mudó el año pasado al condado de Wake, un lugar con más de 1 millón de habitantes y parte del área metropolitana de Raleigh-Cary, le dijeron que su hijo no calificaba para servicios especiales. Pronto, empezó a tener problemas: faltaba a clases o recibía sanciones por portarse mal.

Luego, en marzo, su marido recibió una llamada de su hijo, quien le dijo en voz baja: “Ven a buscarme. Aquí no estoy seguro”.

Después de que supuestamente pateara una pelota de fútbol que le pegó a un empleado, el niño de 9 años fue restringido físicamente por dos hombres que trabajan en la escuela, según Ryan. El incidente dejó al niño con la nariz sangrando y hematomas en la pierna, la columna y el muslo, según los registros médicos.

El distrito escolar del condado de Wake no respondió a preguntas sobre los eventos descriptos en los registros.

Ryan dijo que, después del incidente, su hijo no quizo ir más a la escuela. Perdió el resto de cuarto grado.

“Es repugnante”, dijo Ryan, de 39 años, que fue maestra de educación especial en  las escuelas del condado de Wake hasta que renunció en junio. “Nuestros niños están siendo abusados”.

El distrito no registró el incidente en PowerSchool, el software que brinda a los padres información sobre el desempeño de sus hijos en la escuela, incluyendo calificaciones, resultados de exámenes, asistencia y disciplina, dijo Ryan.

En agosto, el hijo de Ryan comenzó a tomar clases en otra escuela del condado de Wake. A fines de octubre, según los registros médicos y escolares, fue restringido físicamente o aislado dos veces en menos de dos meses.

Guy Stephens, fundador y director ejecutivo de Alliance Against Seclusion and Restraint, con sede en Maryland, dijo que fundó el grupo sin fines de lucro hace más de cuatro años, después de enterarse de que su propio hijo temía ir a la escuela porque había sido restringido y aislado en múltiples ocasiones.

Stephens dijo que algunos niños sometidos a estas prácticas pueden empezar a mostrar actitudes violentas en su casa, autolesionarse o caer en una depresión severa. Estos efectos son tan nocivos, dijo, que forman parte del “camino de la escuela a la prisión”.

“Cuando se interviene físicamente, se pone a más personas en peligro”, dijo Stephens. “Los están encaminando hacia una vida arruinada”.

En mayo, un grupo de legisladores federales propuso el proyecto de ley “Keeping All Students Safe” (“Manteniendo Seguros a Todos los Estudiantes), que prohibiría a las escuelas que reciben dinero de impuestos federales aislar a los niños o usar técnicas de restricción que limiten la respiración.

El senador Chris Murphy (demócrata de Connecticut) y otros partidarios del proyecto han dicho que se necesita una ley federal, en parte porque algunos distritos intencionalmente no reportan el número correcto de incidentes.

Defensores reconocen que es poco probable que el Congreso apruebe el proyecto de ley en el corto plazo.

Históricamente, los administradores escolares incluyendo AASA, una asociación nacional de superintendentes escolares, se han opuesto a leyes similares, argumentando que a veces la restricción y el aislamiento son necesarios para proteger a los estudiantes y al personal en situaciones peligrosas.

El portavoz de AASA, James Minichello, declinó comentar para esta nota.

Staten dijo que les rogó a los funcionarios de la escuela primaria Buckhorn Creek y al distrito que eliminaran la restricción y el aislamiento del plan de educación especial de su hijo, según muestran los documentos. Los funcionarios denegaron la solicitud.

“Siento que me estaban obligando a aceptarlo”, dijo Staten. “Fue manipulador”. Staten y su esposo ahora educan a su hijo en casa. Dijo que ya no tiene arrebatos emocionales como cuando estaba en la escuela pública, porque se siente seguro.

“Es como un niño completamente nuevo”, dijo Staten. “A veces parece que todo fue un mal sueño”.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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]]> 1806223 ‘I’m Not Safe Here’: Schools Ignore Federal Rules on Restraint and Seclusion https://kffhealthnews.org/news/article/restraint-seclusion-schools-students-disabilities-reporting-requirements-ignored/ Wed, 17 Jan 2024 10:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1796421 Photos show blood splattered across a small bare-walled room in a North Carolina school where a second grader repeatedly punched himself in the face in the fall of 2019, according to the child’s mom.

His mother, Michelle Staten, said her son, who has autism and other conditions, reacted as many children with disabilities would when he was confined to the seclusion room at Buckhorn Creek Elementary.

“I still feel a lot of guilt about it as a parent,” said Staten, who sent the photos to the federal government in a 2022 complaint letter. “My child was traumatized.”

Documents show that restraint and seclusion were part of the special education plan the Wake County Public School System designed for Staten’s son. Starting when he was in kindergarten in 2017, Staten said, her son was repeatedly restrained or forced to stay alone in a seclusion room.

Federal law requires school districts like Wake County to tell the U.S. Department of Education every time they physically restrain or seclude a student.

But the district, one of the largest in the nation, with nearly 160,000 children and more than 190 schools, reported for nearly a decade, starting in 2011, that it had zero incidents of restraint or seclusion, according to federal data.

Staten said she was alarmed to learn about the district’s reporting practices, and in March 2022 she sent a complaint letter to the Department of Education’s Office for Civil Rights. When the district set up her son’s special education plan, she wrote, “they said things like ‘it’s for his safety and the safety of others.’”

Further, she wrote, in his district files, “nowhere in the record was there documentation of the restraints and seclusion.”

The practice is “used and is used at often very high rates in ways that are quite damaging to students,” said Catherine Lhamon, assistant secretary for the Office for Civil Rights.

The Department of Education says it is meeting with schools that underreport cases of restraint and seclusion, tactics used disproportionately on students with disabilities and children of color like Staten’s son.

Lhamon called the practices “a life-or-death topic” and noted the importance of collecting accurate federal data. Secretary of Education Miguel Cardona announced new guidance to schools in 2022, saying that, “too often, students with disabilities face harsh and exclusionary disciplinary action.”

‘Children With Bruises’

For more than a decade, school nurses, pediatricians, lawmakers, and others have warned that restraint and seclusion can cause long-lasting trauma and escalate negative behaviors. In the worst cases, children have reportedly died or suffered serious injury.

“In an ideal world, it should be banned,” said Stacey Gahagan, an attorney and civil rights expert who has successfully represented families in seclusion and restraint cases. The tactics are “being used in ways that are inappropriate. I’m seeing parents with pictures of children with bruises and children afraid to go to school.”

No federal law prohibits restraint and seclusion, leaving a patchwork of practices across states and school districts with little oversight and accountability, according to parents and advocates for people with disabilities.

Tens of thousands of restraint and seclusion cases are reported to the federal government in any given year. But those are likely undercounts, say parents and advocates for students, because the system relies on school staff and administrators to self-report. It’s a failing even the Department of Education acknowledges.

“Sometimes school communities are making a deliberate choice not to record,” Lhamon said.

The Wake County Public School System declined to answer questions about Staten’s case for this article, citing student privacy law.

A 2022 report to Congress found North Carolina schools handed lengthy suspensions or expulsions to students with disabilities at the highest rate in the nation.

The district in 2022 submitted revised restraint and seclusion data to the federal government dating to the 2015-16 school year, said Matt Dees, a spokesperson for the Wake County Public School System, where Staten’s son attended school. In a written statement, he said federal reporting rules had been confusing. “There are different guidelines for state and federal reporting, which has contributed to issues with the reporting data,” Dees said.

But parents and advocates for children with disabilities don’t buy that reasoning. “That explanation would be plausible if they reported any” cases, Gahagan said. “But they reported zero for years in the largest school district in our state.”

Hannah Russell, who is part of a network of parents and advocates in North Carolina that helps families navigate the system, said even when parents present pictures of their injured children, the school systems will say “it didn’t happen.”

In North Carolina, 91% of districts reported zero incidents of restraint and seclusion during the 2015-16 academic year, the second-highest percentage in the nation after Hawaii, a federal report found.

“This was a problem before covid,” said Russell, a former special education teacher who said one of her own children with special needs was restrained and secluded in school. “It is an astronomical problem now.”

North Carolina’s Department of Public Instruction, which oversees public schools statewide, did not make officials available for interviews and did not answer written questions.

In an email, spokesperson Jeanie McDowell said only that schools receive training on restraint and seclusion reporting requirements.

Educators are generally allowed to use restraint and seclusion to protect students and others from imminent threats to safety. But critics point to cases in which children have died or suffered post-traumatic stress disorder and other injuries for minor transgressions such as failing to stay seated or being “uncooperative.”

Zero Incidents Reported

In 2019, the Government Accountability Office, which conducts research for Congress, said some school systems almost never tell the federal government about the use of restraint and seclusion. About 70% of U.S. school districts report zero incidents.

The Department of Education’s “quality control processes for data it collects from public school districts on incidents of restraint and seclusion are largely ineffective or do not exist,” a 2020 GAO report said.

Lhamon said her office is conducting investigations across the country and asking districts to correct inaccurate data. The Department of Education wants school districts to voluntarily comply with federal civil rights law protecting students with disabilities. If they don’t, officials can terminate federal financial assistance to districts or refer cases to the Department of Justice.

The Wake County Public School System settled a lawsuit last year after the district did not report any use of restraint or seclusion in the 2017-18 school year, even though a student was secluded or restrained and witnessed the practices used with other children, according to Gahagan, who represented the student’s family.

As part of the settlement, the district agreed to notify parents by the end of each school day if their child had been restrained or secluded that day.

Gahagan said transparency would increase in Wake County but that problems persist across the country. Schools sometimes keep seclusion incidents hidden from parents by calling them “timeouts” or other euphemisms, Gahagan said.

“For most parents a ‘timeout’ doesn’t mean being put in a closet,” Gahagan said. “What is the recourse for a parent? There are not a lot of checks and balances. There is not enough accountability.”

Still, Gahagan, a former teacher, expressed sympathy for educators. Schools lack money for counselors and training that would help teachers, principals, and other staff learn de-escalation techniques, which could reduce reliance on physical interventions, she said.

Jessica Ryan said that in New York City, her son, who has autism, received counseling, occupational therapy, and a classroom with a standard education teacher and a special education teacher.

But when Ryan’s family moved last year to Wake County, home to more than 1 million people and part of the famed Research Triangle region, she was told he didn’t qualify for any of those services in the district, she said. Soon, her son started getting in trouble at school. He skipped classes or was written up for disruptive behavior.

Then in March, she said, her husband got a phone call from their son, who whispered, “Come get me. I’m not safe here.”

After the 9-year-old allegedly kicked a foam soccer ball and hit a school employee, he was physically restrained by two male school staffers, according to Ryan. The incident left the boy with a bloody nose and bruises on his leg, spine, and thigh, the medical records say.

The Wake County school district did not respond to questions about the events described in the documents.

After the incident, Ryan said, her son refused to go to school. He missed the remainder of fourth grade.

“It is disgusting,” said Ryan, 39, who said she was a special education teacher in Wake County schools until she resigned in June. “Our kids are being abused.”

The district did not record the incident in PowerSchool, a software system that alerts parents to grades, test scores, attendance, and discipline, Ryan said.

In August, Ryan’s son began classes at another Wake County school. By late October, school and medical records say, he was restrained or secluded twice in less than two months.

Guy Stephens, founder and executive director of the Alliance Against Seclusion and Restraint, a nonprofit advocacy group based in Maryland, said he founded the group more than four years ago after he learned his own son was afraid to go to school because he had been repeatedly restrained and secluded.

Stephens said some children subjected to the practice may start to act out violently at home, harm themselves, or fall into severe depression — impacts so adverse, he said, that they are a common part of the “school-to-prison pipeline.”

“When you go hands-on, you are putting more people in danger,” Stephens said. “These lives are being set on a path to ruin.”

In May, federal lawmakers proposed the Keeping All Students Safe Act, a bill that would make it illegal for schools receiving federal taxpayer money to seclude children or use restraint techniques that restrict breathing. Sen. Chris Murphy, a Connecticut Democrat, and other supporters have said a federal law is needed, in part, because some districts have intentionally misreported numbers of restraints and seclusions.

Advocates acknowledge Congress is unlikely to pass the bill anytime soon.

School administrators, including AASA, a national association of school superintendents, have historically opposed similar legislation, saying that restraint and seclusion are sometimes needed to protect students and staff in dangerous situations.

AASA spokesperson James Minichello declined comment for this article.

Staten said she begged officials at Buckhorn Creek Elementary and the district to remove restraint and seclusion from her child’s special education plan, documents show. Officials denied the request.

“I feel like they were gaslighting me into accepting restraint and seclusion,” Staten said. “It was manipulative.”

Staten and her husband now home-school their son. She said he no longer has emotional outbursts like he did when he was in public school, because he feels safe.

“It’s like a whole new kid,” Staten said. “It sometimes feels like that was all a bad dream.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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]]> 1796421 ‘I Am Just Waiting to Die’: Social Security Clawbacks Drive Some Into Homelessness https://kffhealthnews.org/news/article/social-security-clawbacks-homelessness/ Wed, 20 Dec 2023 10:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1785329 More than a year after the federal government first cut off her disability benefits, Denise Woods drives nightly to strip malls, truck stops, and parking lots around Savannah, Georgia, looking for a safe place to sleep in her Chevy.

Woods, 51, said she had rented a three-bedroom house she shared with her adult son and grandson until March 2022, when the government terminated her disability payments without notice.

According to letters sent by the Social Security Administration, the agency determined it had been overpaying Woods and demanded she send back nearly $58,000.

Woods couldn’t come up with the money. So, until February 2026, the agency is withholding the $2,048 in disability she would have received each month.

“I still don’t know how it happened,” said Woods, who has requested a waiver and is seeking a hearing. “No one will give me answers. It takes weeks or months to get a caseworker on the phone. They have made my life unbearable.”

Kilolo Kijakazi, acting commissioner of the Social Security Administration, told a congressional subcommittee in October that her agency notifies recipients when they have received overpayments and works to “help those who want to establish repayment plans or who seek waiver of the debt.”

But relief from overpayments goes to only a relatively small number of people. And many others face dire consequences: Some become homeless, are evicted from rental housing, or see their mortgages fall into foreclosure.

The SSA has a painful legacy of excluding Black people from benefits. Today the agency’s own published research shows its overpayments most often hit Black and Hispanic people, the poorest of the poor, those with the least education, and those whose medical conditions are unlikely to improve.

Woods is one of millions who have been targeted in the Social Security Administration’s attempt to claw back billions of dollars it says was wrongly sent to beneficiaries. Years can pass before the agency catches a mistake, and even the little bit extra it might send each month can add up.

In reclaiming it, the government is imposing debts that can reach tens of thousands of dollars against those least able to pay.

(WHIO-TV, Dayton)

(WSOC-TV, Charlotte)

‘Wreaking Havoc in People’s Lives’

KFF Health News and Cox Media Group reporters interviewed people who have received overpayment notices and nonprofit attorneys who advocate for them and reviewed SSA publications, policy papers, and congressional testimony.

A 64-year-old Florida man said he could no longer afford rent after his Social Security retirement payments were garnished last year because he allegedly had been overpaid $35,176 in disability benefits. He said he now lives in a tent in the woods. A 24-year-old Pennsylvania woman living with her mother and younger siblings in public housing lost the chance to buy her own home because of an alleged $6,063 overpayment that accrued when she was a child.

“Social Security overpayments are wreaking havoc in people’s lives,” said Jen Burdick, an attorney with Community Legal Services of Philadelphia, which represents clients who have received overpayment notices. “They are asking the poorest among us to account for every dollar they get. Under their rules, some people can save up money for a funeral burial but not enough to get housing.”

Woods has lupus and congestive heart failure and struggles to walk, but she started working part-time after her benefits were rescinded. She said she makes $14 an hour transporting railroad crew members in her 2015 Chevy Equinox between Savannah and Jacksonville, Florida, when she can get assignments and her health allows it.

The SUV costs $386 a month — a large portion of her income — but without it, Woods said, she would not have a job or a place to sleep.

“My life is just survival now,” Woods said. “Sometimes I feel like I am just waiting to die.”

The Social Security Administration has said it is required by law to attempt to recover overpayments. Notices ask beneficiaries to repay the money directly. Authorities can also recoup money by reducing or halting monthly benefits and garnishing wages and federal tax refunds.

Agency officials describe an orderly process in which they explain to beneficiaries the reason for the overpayment and offer the chance to appeal the decision and have the charges waived if they cannot afford it. One way to qualify for a waiver is if “paying us back would mean you could not pay your bills for food, clothing, housing, medical care or other necessary expenses,” according to a letter sent to one recipient.

Those most impacted by Social Security’s decisions, including people with disabilities and widows receiving survivors’ benefits, paint a different picture. They talk about having their benefits terminated without explanation or warning, an appeals process that can drag on for years, and an inability to get answers from the SSA to even basic questions.

Nancy Altman, president of Social Security Works, a group that pushes for the protection and expansion of the program, recalled how stressful it was when a colleague’s mother received an overpayment notice.

“After weeks of nonstop phone calls, he was able to get the matter resolved, but not before it put his mother in the hospital,” Altman said. “One can just imagine how much worse it would be for someone for whom English is not their native language, who lacks a high school education, and who is unassisted by such a knowledgeable and caring advocate.”

Problems surrounding the Social Security Administration are aggravated by congressional actions, including funding shortages that brought agency staffing to a 25-year low by the end of fiscal year 2022. Even so, advocates for people with disabilities say the agency does far less than it could to help people who have been overpaid, often through no fault of their own.

They said challenges faced by beneficiaries underscore how overpayments disproportionately impact Black people and other minority groups even as President Joe Biden and Social Security leaders promise to fix racial inequity in government programs.

Most overpayments are linked to the Supplemental Security Income program, which gives money to people with little or no income who are disabled, blind, or at least 65. The majority of SSI recipients are Black, Hispanic, or Asian people.

“Congress has turned a blind eye to this,” said David Weaver, a former associate commissioner for research, demonstration, and employment support at the SSA. Politicians “just want to save money. It is misplaced priorities. It is completely inexcusable.”

The Social Security Administration did not make its leaders available for an interview. Spokesperson Nicole Tiggemann declined to answer questions about the cases of Woods and other beneficiaries, citing privacy laws.

In a written statement, Tiggemann acknowledged that receiving an overpayment notice can be “unsettling,” but said the agency helps beneficiaries navigate the process and informs them of their rights if they believe they were not at fault or cannot repay the debt.

“Even if they do not want to appeal or request a waiver, the notice says to contact us if the planned withholding would cause hardship,” Tiggemann said. “We have flexible repayment options — including repayment of as low as $10 per month. Each person’s situation is unique, and we handle overpayments on a case-by-case basis.”

Critics say fighting an overpayment notice is not that simple.

Beneficiaries — many challenged by physical, mental, or intellectual disabilities — often are overwhelmed by complex paperwork or unable to find financial documents that may be years old.

The Social Security Administration has the authority to waive overpayments if officials determine recovering them would violate “equity and good conscience,” or the disputed amount falls below certain thresholds. The agency’s guidance also says collecting an overpayment “defeats the purpose” when the “individual needs substantially all of their current income to meet their current ordinary and necessary living expenses.”

Advocates for people with disabilities contend most overpayments arise from delays in processing paperwork and errors by the Social Security Administration or recipients making innocent mistakes. The agency can waive overpayments when the beneficiary is found not at fault.

But in fiscal year 2023, the Social Security Administration collected about $4.9 billion in overpayments with an additional $23 billion yet uncollected, according to an agency report. Just $267 million was waived, the report said.

David Camp, the interim chief executive officer of the National Organization of Social Security Claimants’ Representatives, which advocates for improvements in federal disability programs, said the Social Security Administration is a “broken structure.”

The agency sometimes tries to claw back overpayments from people falsely accused of failing to provide required documents, Camp said.

“Dropping off forms at their field offices is not a guarantee” paperwork will be processed, he said. “Mail is slow, or it doesn’t get opened. We see it so many times you are left with the idea that has to do with the structure.”

(WFXT-TV, Boston)

(WJAX-TV, Jacksonville)

Left Destitute

Advocacy groups and others said they don’t know how many people become homeless after their benefits are terminated, but they say anecdotal accounts are common.

A study found that more than 800,000 disability applicants from 2007 to 2017 experienced homelessness. Advocates say it only makes sense that overpayments could lead more people to become homeless, since nearly 40% of people receiving disability benefits experience food insecurity and cannot keep up with their rent and utility bills, according to research.

Ronald Harrell sleeps in the woods near Wildwood, Florida, about 50 miles northwest of Orlando. He said he shelters in a tent, cooks his meals on a small grill, and showers at a friend’s house.

Harrell, 64, said he rented a room in a house for $125 a week until last year, when the Social Security Administration cut off his retirement benefits.

A letter the SSA sent him, dated Feb. 6, 2023, says his benefits are being withheld because of overpayment of $35,176 that accrued when Harrell received disability payments. The letter acknowledges he has asked the agency to lower his payments.

“I don’t know how they are doing this to me,” Harrell said. “I did everything by the law.”

Harrell said he once worked as an HVAC technician, but nerve damage left him unable to work sometime around 2002.

He said he collected disability benefits until about 2009, when rehabilitation allowed him to return to the workforce, and he said he reported the information to the federal government. Harrell said he applied for early Social Security retirement benefits last year when his health again declined.

“I started working when I was 16,” Harrell said. “I never thought my life would be like this.”

Kijakazi, the acting Social Security commissioner, and others have said overpayments stem at least partly from low staffing and budget cuts.

From 2010 to 2023, the agency’s customer service budget dropped by 17%, after inflation, according to a report by the Center on Budget and Policy Priorities, a think tank that conducts research on government programs.

At the same time, the report says, the number of Social Security beneficiaries grew by nearly 12 million people, or 22%.

Jonathan Stein, a former attorney with Community Legal Services of Philadelphia who has participated in workgroups and meetings with federal officials about access to Social Security payments for vulnerable populations, said budget cuts cannot fully account for the agency’s penchant for denying applications and terminating benefits.

Officials suspended Supplemental Security Income benefits for about 136,540 people in 2019 for “failure to furnish report,” which means they did not meet deadlines or paperwork requirements, Stein said, despite knowing many of those people were unable to contact the agency because they are homeless or have been evicted and lost access to phones and computers.

That’s more than double the number in 2010, he said.

“They have an implicit bias for denying benefits,” Stein said. “It is a very skewed view of integrity. It reinforces a culture of suspicion and prosecution of applicants.”

The 24-year-old Pennsylvania woman who received Supplemental Security Income as a child because of a learning disability described her ordeal on the condition that her name not be published. A letter from the Social Security Administration says she received an overpayment notice for more than $6,000.

“It was frustrating,” the woman said. “You are dealing with nasty people on the phone. I couldn’t get any answers.”

In November 2022, she contacted a nonprofit law firm, which helped her file an appeal. One year later, she received another letter from Social Security saying the overpayment had been waived because it was not her fault. The letter also said officials would not seek repayment because she could not afford basic needs such as food and housing without the monthly benefits.

The woman had already paid a price.

She lived in public housing and the Philadelphia Housing Authority had offered her a chance to fulfill a long-held goal of owning a house. But when the overpayment appeared on her credit report, she said, she could not obtain a mortgage.

“I was excited about getting my own home,” she said. “That’s what everybody wants. Losing it is not a good feeling.”

David Hilzenrath of KFF Health News, Jodie Fleischer of Cox Media Group, and Ben Becker of ActionNewsJax in Jacksonville, Florida, contributed to this report.

Do you have an experience with Social Security overpayments you’d like to share? Click here to contact our reporting team.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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]]> 1785329 The Painful Pandemic Lessons Mandy Cohen Carries to the CDC https://kffhealthnews.org/news/article/painful-covid-pandemic-lessons-mandy-cohen-north-carolina-cdc/ Wed, 23 Aug 2023 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1729765 CHARLOTTE, N.C. — As covid-19 devastated communities across the nation in spring 2020, a group of Black ministers in this racially divided city made an urgent plea for more testing in their neighborhoods.

Testing at the time “was outside of communities of color,” said the Rev. Jordan Boyd, pastor of Rockwell AME Zion Church in Charlotte. For Boyd, pandemic losses were personal: Covid-related complications killed a brother-in-law who worked as a truck driver. “We saw what was happening with our folks.”

Mandy Cohen, who led the state’s pandemic response as secretary of North Carolina’s health department, had said widespread testing was one of “our best tools to keep our community safe and to protect our frontline workers.” But the state was failing to get tests to its most vulnerable people, with grim consequences: Black people in North Carolina were getting sick and dying from covid-related causes at far higher rates than white people, data show.

KFF Health News analyzed and confirmed publicly available data, including the location of testing sites that Cohen’s office directed the public to in mid-May 2020 in Mecklenburg County, home to Charlotte, the state’s largest city. Just 1 in 4 fixed sites stood in more disadvantaged areas with significant Black populations, including what is known as the Crescent, neighborhoods reaching west, north, and east of downtown that for generations have had elevated rates of diabetes, high blood pressure, lung disease, and other conditions that can cause life-threatening complications from covid. Far more testing was available in south Charlotte and suburban areas — the whiter, wealthier neighborhoods.

Life in the Crescent is marked by higher rates of poverty, crowded housing, and less access to health care, transportation, and internet service — factors that fueled transmission of the virus and created barriers to testing.

“There were a lot of hurdles that you had to go through,” said Boyd, who helped spearhead the effort to bring testing to Black churches.

President Joe Biden and others in political and health policy circles have praised Cohen’s pandemic leadership in North Carolina. Biden in June cited her “proven track-record protecting Americans’ health and safety” when elevating Cohen to run the Centers for Disease Control and Prevention, the nation’s top public health agency.

Those on the ground in North Carolina’s most vulnerable communities, including Cohen’s admirers, tell another story — about living with the downsides of the state’s emergency response. These include advocates for groups that were disproportionately harmed during the public health crisis, including minority and immigrant communities, people with disabilities, and families of nursing home residents.

Corine Mack, president of the Charlotte-Mecklenburg NAACP, recalled that in late 2020 she and others complained to Cohen about public money going to white-led organizations instead of Black-led ones working in minority neighborhoods.

“I said we had to send resources tomorrow, not next month,” Mack said. “She started crying. I was so passionate about our people dying. Once she understood the severity of the situation, she did what she had to do.”

The challenges Cohen faced in North Carolina were exacerbated by structural inequities in and outside the health care system, problems that are too large for any one person to fix. Still, Cohen now faces the same challenges on a national scale, as she’s charged with fixing the CDC after its pandemic missteps.

Cohen, through her spokesperson at the CDC, declined multiple requests for an interview.

A report in January called “Building the CDC the Country Needs,” which was signed by dozens of health policy experts, urged an agency overhaul. Among the priorities cited: more quickly collecting data on racial, ethnic, economic, and geographic factors that is “foundational to improving equity of access to services.”

For most of the pandemic, Black, Hispanic, and Native Americans fared worse than whites across the country.

In North Carolina, critics and allies alike say Cohen heeded concerns. She relied heavily on data and followed federal guidance closely, they said. And Cohen showed vigilance when she interpreted rules, like those on nursing home visitation and mask mandates, even in the face of criticism.

She also repeatedly urged personal responsibility to contain the spread of the virus, underscoring how public health messaging often focuses on choice rather than societal constraints, said Anne Sosin, a researcher at Dartmouth College who focuses on health equity.

“Many of the people and communities hardest-hit by the pandemic had little choice in their exposure” because they got covid where they lived or worked, Sosin said. “Limiting our focus on the choices that people make — rather than on the broader structural and social forces that shape risk — really will set us up for the same failures in the future.”

With more than 1 million residents, Mecklenburg County has become a symbol both of North Carolina’s economic rise and of its struggles to overcome a long history of racial discrimination and disparities. A short drive from the headquarters of Fortune 500 companies, such as Bank of America and Honeywell, sit minority neighborhoods plagued by poverty. A national study on social mobility found that, among the 50 largest cities, Charlotte was the hardest place for a child to move from poverty to the upper class.

Researchers from North Carolina’s health agency and the University of North Carolina found that access to tests during the first three months of the pandemic — between March and June 2020 — was not evenly distributed across racial and ethnic groups, with inadequate access for Black and Latino residents.

On May 14, 2020 — two months after the national emergency was declared — Cohen’s agency directed clinicians to prioritize testing for people from “racial and ethnic minority groups disproportionately affected by adverse COVID-19 outcomes,” and officials recommended using mobile testing for “vulnerable populations,” documents show.

The disparities persisted. In Charlotte, the difference in testing sites underscored the inequity people of color often face in health care, as they were left to depend on a few mobile units whose routes and hours varied by the day. Meanwhile, wealthier areas had an abundance of well-resourced, fixed sites with regular hours.

Critics say the state was slow to address glaring and predictable problems. Mecklenburg County Commissioner Pat Cotham, a Democrat, said it took authorities precious time to shift testing to the hardest-hit neighborhoods. Cotham said officials should have more quickly enlisted Black ministers and others who had established trust with residents. Instead, she said, even elected representatives of those areas were often locked out. “I remember getting information from press releases or TV,” she said.

North Carolina initially failed to prioritize testing for people who were exposed to covid because of where they live or work, said Jeanne Milliken Bonds, a professor of social impact investing at the University of North Carolina. She co-authored a white paper that criticized the national pandemic response, saying, “We are ignoring the critical impact of systemic racism in vulnerabilities to the deadly virus.”

Black people, immigrants, and ethnic minorities disproportionately hold jobs that governments deemed essential — in food processing plants, retail stores, and nursing homes — and they were unable to isolate and work from home, Milliken Bonds said.

Charlotte had one of the biggest disparities in access to testing in the nation, according to a study of 30 large cities by researchers at Drexel and Temple universities. Only Austin and Houston in Texas fared worse.

In 2020, Black people in North Carolina died from covid at a higher rate than white people, although the disparity was slightly less pronounced than in the U.S. overall. A KFF Health News analysis of CDC data shows that 112 of every 100,000 non-Hispanic Black residents in the state died, compared with 89 per 100,000 non-Hispanic white residents. North Carolina’s death rates for all racial and ethnic groups that year were lower than those nationally.

“The driving factor for testing and vaccination was, ‘Let’s get older people and let’s protect our health care workers,’” Milliken Bonds said. “You end up losing the health equity lens. There was a course correction later in 2020. They looked at the data and said, ‘Oh my God!’ They were missing people of color.”

Tensions Rose

In April 2020, when covid tests were scarce nationally and states had little federal support, Cohen’s Department of Health and Human Services convened a work group to increase testing. The initiative began as Democratic Gov. Roy Cooper indicated he would ease the restrictions he’d put in place in March to limit covid’s spread.

The group included state employees, consultants, local officials, and representatives from major hospital systems, community health centers, and commercial labs, North Carolina HHS news releases and state documents show. Officials set priority groups for testing, including hospitalized patients, health care workers and first responders, and people in long-term care or correctional facilities, according to meeting minutes from April 24. The last item: “additional emphasis on equity and ensuring communities of color have access to testing.”

The state also received guidance from experts focused on equity.

“We know that there’s more covid-19 out in our communities than gets captured by what’s in our lab data,” Cohen said April 30, during one of Cooper’s pandemic briefings.

Of the covid test results reported to North Carolina’s health department at that time, a smaller share were coming back positive relative to prior weeks, and covid hospitalizations were level — developments Cohen hailed as progress. But tensions were brewing.

By May 5, Disability Rights North Carolina filed a civil rights complaint with the U.S. Department of Health and Human Services about a proposed state emergency plan. The advocacy group said the plan — which determined who would get lifesaving treatments in hospitals if supplies were scarce — would put people with disabilities in the “back of the line” and lead to a disproportionate death toll among people of color or with low incomes.

As the state began reopening businesses in early May, officials knew testing levels were not adequate, according to a review of public documents, interviews, and Cohen’s public remarks. Hundreds of sites were up and running, “but there’s more to do,” Cohen said May 20.

In a letter in the North Carolina Medical Journal, North Carolina HHS employees and a consultant with Accenture said “testing was difficult to access outside of a hospital” that month. “Of the tests being performed early in the pandemic, the majority were in White populations even though we could already see differences in poor outcomes in Black/African American, American Indian/Alaskan Native, and Latinx populations infected with the virus around the country,” they wrote.

Kody Kinsley, who worked for Cohen and succeeded her as health secretary, said the state’s response was stymied by factors beyond its control, including supply chain shortages. “We were essentially riding the backbone of the existing health care network with inadequate supplies,” Kinsley said. The department tried to contract with outside firms to boost testing access in historically marginalized communities, but “resources weren’t available.”

Boyd, the pastor, said it was “difficult times.” To reach hard-hit communities across the state, “you have to be able to do that through connections on the ground,” he said. “Otherwise it’s not going to happen. But that takes time.”

In Charlotte, he said, fixed testing sites at hospitals and elsewhere, which required appointments, weren’t as accessible for those in the city’s poorest neighborhoods. “You had to go online and sign up,” he said.

Black residents were desperate for testing: When a mobile van run by Atrium Health, the dominant hospital system in Charlotte, arrived at Boyd’s church in early May, “Cars were lined up around the block at 4 or 5 o’clock in the morning,” he said.

Atrium’s mobile testing started in April, circulating in minority communities where data showed emerging hot spots. While people could walk up to get a test, locations shifted daily, according to internet archives, social media posts, and other announcements. Between mid-April and early July, the units stopped at many Black churches only once.

“We were last on the list. We lost a lot of people,” said Vilma Leake, a Democratic member of the Mecklenburg Board of County Commissioners. Leake said she never received a satisfactory answer when she asked why people of color were not prioritized for testing given the South’s long history of racial exclusion and wide disparities in health, education, and income. “History is repeating itself. It is always a fight for some people,” she added.

Kinsley said the state’s response “was intentionally designed to be conscious of class and race and ethnicity,” which he said informed its guidance for essential workers and efforts to push businesses to provide paid leave and on-the-job covid tests.

By late spring, the state’s testing data, which captured only a fraction of infections, painted a troubling picture. As of May 26, Black residents made up 31% of cases and 35% of deaths despite being 22% of the state’s population. Latinos made up 9.6% of the state’s population and 35% of covid cases.

That same day, Cohen stood at Cooper’s pandemic briefing. While she described the state’s efforts to improve safety for workers at meat processing plants, she again called for personal responsibility.

“Our ability to continue to ease restrictions and get back to work as safely as possible hinges on all of us working together to protect each other,” Cohen said, adding, “We want to save lives. And we can do that with simple individual actions.” By that time, North Carolina had allowed restaurants, pools, and personal care businesses such as barbers to open at 50% capacity.

The state’s response “was not adequate for protecting essential workers,” said the Rev. Rodney Sadler, the director of the Center for Social Justice and Reconciliation at Union Presbyterian Seminary.

“It was targeted toward those who had resources, who had a knowledge base, who had greater freedoms, who had the ability to work from home,” he said, adding that it’s important to “think about how this hits differently for poor Black and brown people in inner-city communities than it does for wealthier, white communities in the suburbs.”

The Rev. Greg Jarrell helps lead QC Family Tree, a social justice organization in Enderly Park, a Black neighborhood near downtown Charlotte that is gentrifying. He said people often waited hours for testing at a site near his neighborhood, even with appointments.

“We saw the severe limitations of the whole system,” he said. “Who has got time to sit in line for three hours? Not an hourly employee.”

If you don’t set up “race-conscious and class-conscious policy,” Jarrell said, “the system is always going to serve people who have more resources.”

Throughout June, as North Carolina’s covid infections and hospitalizations climbed, the state focused more intensely on Black, Latino, and Native American residents. It took until July 7 for officials to announce they would deploy 300 free temporary testing sites in underserved communities across the state.

The state’s covid death toll had reached 1,420 people, and 989 more were hospitalized. The trajectory, Cohen said, was “moving in the wrong direction.”

A Bigger Challenge at the CDC

Political leaders, public health experts, and advocacy groups say Cohen is well suited to run the CDC.

She has navigated vast government agencies — experience her predecessor, Rochelle Walensky, lacked. Cohen has political acumen, having worked effectively in a politically divided state “with a range of views about public health,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security and a former senior White House adviser on covid response. “She is super bright and a very clear communicator about the issues on the table.”

During the Obama administration, Cohen, a physician, climbed the ranks to become chief operating officer and chief of staff at the Centers for Medicare & Medicaid Services, which has more than 6,000 employees and oversees government programs like Medicare and Medicaid that insure millions of Americans. In 2017 Cooper appointed her North Carolina health secretary. She stepped down at the end of 2021.

Cohen’s time “in North Carolina will inform the practical, on-the-ground work that will make a big difference at the CDC,” Kinsley said, citing efforts to minimize racial and ethnic disparities in covid vaccination.

According to CDC data comparing covid mortality rates by state, North Carolina had the 12th lowest age-adjusted death rate in 2020. But the state’s fortunes changed in 2021, when it dropped to 30th place. North Carolinians said Cohen listened to their perspectives, but their calls for help were punctuated by a drumbeat of deaths.

Mecklenburg County Commissioner Mark Jerrell, a Democrat, said the pandemic exposed how North Carolina is still reeling from centuries of racial discrimination. Even as Cohen “became a trusted community voice,” he said, “there was a disconnect between the discussion of equity and the application of equity.”

He worries that painful lessons of those early pandemic months seem forgotten, saying, “We don’t even hear this conversation now.”

Data reporter Hannah Recht contributed to this story.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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]]> 1729765 A Mom Owed Nearly $102,000 for Hospital Care. Her State Attorney General Said to Pay Up. https://kffhealthnews.org/news/article/north-carolina-attorney-general-medical-debt-collection/ Thu, 20 Jul 2023 09:00:00 +0000 https://kffhealthnews.org/?post_type=article&p=1718350 Bridget Narsh’s son, Mason, needed urgent help in January 2020, so she was offered the chance to send him to Central Regional Hospital, a state-run mental health facility in Butner, North Carolina.

The teen, who deals with autism and post-traumatic stress and attention-deficit/hyperactivity disorders, had started destroying furniture and running away from home. His mother worried for the safety of Mason and the rest of the family.

But children in crisis in North Carolina can wait weeks or months for a psychiatric bed because the state lacks the services to meet demand. And when spots do become available, they are expensive.

The standard rate at Central Regional was $1,338 a day, which Narsh could not afford. So, when a patient relations representative offered a discounted rate of less than $60 a day, her husband, Nathan, signed an agreement.

Mason, now 17, was hospitalized for more than 100 days in Central Regional over two separate stays that year, documents show.

But when requests for payment arrived the following year, Narsh said she was shocked. The letters — which were marked “final notice” and requested immediate payment — were signed by a paralegal in the office of Josh Stein, North Carolina’s attorney general. The total bill, $101,546.49, was significantly more than the roughly $6,700 the Narshes expected to pay under their agreement with the hospital.

“I had to tell myself to keep my cool,” said Bridget Narsh, 44, who lives with her husband and three children in Chapel Hill. “There is no way I could pay for this.”

Medical bills have upended the lives of millions of Americans, with hospitals putting liens on homes and pushing many people into bankruptcy. In recent years, lawmakers have railed against privately operated hospitals, and states have passed laws intended to make medical billing more transparent and limit aggressive debt collection tactics.

Some state attorneys general — as their states’ top law enforcement officials — have pursued efforts to shield residents from harmful billing and debt collection practices. But in the name of protecting taxpayer resources, their offices are also often responsible for collecting unpaid debts for state-run facilities, which can put them in a contradictive position.

Stein, a Democrat running for governor in 2024, has made hospital consolidation and health care price transparency a key issue during his time in office.

“I have real concerns about this trend,” Stein said in 2021 about the state’s wave of hospital consolidations. “Hospital system pricing is closely related to this issue, as consolidations drive up already inordinate health care costs.”

Stein refused an interview request about Mason’s bills, which arrived at the end of 2021 because the North Carolina government suspended debt collection in March 2020 as the nation felt the economic fallout of the covid-19 pandemic.

Across the nation, states seize money or assets, file lawsuits, or take other steps to collect debts from people who stay at state-run hospitals and other institutions, and their efforts can disproportionately affect racial and ethnic minorities and the poor, according to health care consumer advocates. In North Carolina, officials looking to collect unpaid debt are permitted to garnish residents’ income tax refunds.

Attorneys general must balance their traditional role of protecting consumers from harmful debt collection practices and the state’s obligation to serve taxpayers’ interests and fund services, said Vikas Saini, a cardiologist and the president of the Lown Institute, a Massachusetts-based nonpartisan think tank that advocates for health care reform.

The Narsh case is “the perfect storm of every problem in our health care system,” said Saini, who at the request of KFF Health News reviewed the payment demand letters the family received. Far too often health care is unaffordable, billing is not transparent, and patients end up facing enormous financial burdens because they or a loved one is sick, Saini said.

The Narsh family had Blue Cross and Blue Shield health insurance at the time of Mason’s hospitalizations. Bridget Narsh has records showing insurance paid about $7,200 for one of his stays. (Mason is now covered by Medicaid, the state-federal health insurance that covers some people with disabilities and low-income people.)

In a written statement, Nazneen Ahmed, a spokesperson for Stein’s office, said state law requires most agencies to send their unpaid debts to the state Department of Justice, which is charged with contacting people who may owe money.

Ahmed directed KFF Health News to the North Carolina Department of Health and Human Services, which oversees Central Regional Hospital.

Bailey Pennington Allison, an agency spokesperson, said in a written statement that officials researched the Narsh case and determined the state had properly followed procedures in billing the family.

The state bases its rates for services on the costs of the treatment, nursing, professional consultation, hospital room, meals, and laundry, Pennington Allison said. Hospital staffers then work with patients and families to learn about their income and assets to determine what they can afford and what they will be charged, she said.

The spokesperson did not address why Mason’s parents were offered, but did not ultimately receive, a discounted rate both times he was admitted in 2020.

Narsh contacted an attorney, who negotiated the bill with the state. In April, her family reached an agreement with North Carolina officials to pay $100 a month in exchange for the state reducing the charges by roughly 96% to about $4,300. If Narsh defaults, however, the deal stipulates she must come up with the original total.

States can take a variety of approaches to debt collection. North Carolina is one of about a dozen that can garnish residents’ income tax refunds, said Richard Gundling, a senior vice president for the Healthcare Financial Management Association, a membership organization for finance professionals.

Gundling said state officials have a responsibility to protect taxpayer money and collect what is owed but that seizing income tax returns can have more severe consequences for people with lower incomes. “There is a balance that needs to be struck to be reasonable,” he said.

With health care a leading cause of personal debt, unpaid medical bills have become a major political issue in North Carolina.

State lawmakers are considering a bill called the Medical Debt De-Weaponization Act, which would curb the ability of debt collectors to engage in “extraordinary collection” such as foreclosing on a patient’s home or garnishing wages. But the current version of the bill would not apply to state-operated health care facilities like the one Mason Narsh went to, according to Pennington Allison.

In a written statement, Stein said he supports legislative efforts to strengthen consumer protections.

“Every North Carolinian should be able to get the health care they need without being overwhelmed by debt,” Stein said. He called the bill under consideration “a step in the right direction.”

Narsh said the unexpectedly high amount of the bill was frustrating, at least in part because for years she struggled to get Mason more affordable, preventive care in North Carolina. Narsh said she had difficulty finding services for people with behavioral issues, a shortage acknowledged in a state report released last year.

Multiple times, she said, she has been left with no option but to take him to a hospital to be evaluated and admitted to an inpatient mental health facility not suitable for people with complex needs.

Community-based services that allow people to receive treatment at home can help them avoid the need for psychiatric hospitals in the first place, Narsh said. Mason’s condition improved after he received a service dog trained to help people with autism, among other community services, Narsh says.

Corye Dunn is the public policy director at Disability Rights North Carolina, a Raleigh-based nonprofit mandated by the federal government to monitor public facilities and services to protect people with disabilities from abuse. The irony, she said, is that the same system that’s ill-equipped to prevent people from falling into crisis can then pursue them with big bills.

“This is bad public policy. This is bad health care,” Dunn said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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