Tackling gun violence in Detroit: preventing disabilities and making everyone safer

Gun violence is usually covered in terms of deaths and numbers of mass shootings. The survivors of gun violence often become part of the disability community -  when a victim is not killed by an AK-15, for instance, his or her survival, often with grave injuries, may lead eventually to lifelong disabilities and trauma-induced mental distress. The prevention of gun violence should be a concern of disability advocates. 

The Washington Post published an article last November, “Terror on Repeat: A rare look at the devastation caused by AR-15 shootings” by Silvia Foster-Frau, N. Kirkpatrick, and Arelis R. Hernandez, 11/16/23. The article is disturbing and nauseating in its description of what happens to bodies, classrooms, movie theaters, music festivals, and places of worship after a mass shooting event with this popular military style weapon. It is enough to make one re-consider the extent to which the 2nd amendment applies to the "right" to own weapons of mass destruction. If you are already convinced that there are limits to 2nd amendment rights, feel free to skip this article.

There is some good news and progress to report in Detroit where there has been a concerted and coordinated effort to reduce the number of homicides in the city:

“Detroit is close to recording its fewest homicides in nearly 60 years” by Andrea May Sahouri, 12/4/23.

According to the article, “As of Nov. 30, the city had recorded 228 homicides this year, an 18% drop compared to the 276 homicides during the same time last year. In 2018, Detroit recorded 261 homicides, the city's fewest since 1966, a year prior to the Detroit riot in 1967.” Also of note is that the population of Detroit has fallen from 1.58 million people in 1966 to an estimated 620,376 in 2022, but the downward trend in homicides is nevertheless good news for the citizens of Detroit.

A coordinated effort led by Wayne County Executive Warren Evans targeted seven key areas: “Reducing felony gun case backlogs in Wayne County Circuit and 36th District courts; increasing staffing for the Wayne County Prosecutor's and Sheriff's offices, as well as the Detroit Police Department; increasing coordination between the Wayne County prosecutor and DPD on shooting and homicide cases; increasing accountability for defendants released on tether to the Wayne County Sheriff's Office; increasing accountability from the Michigan Department of Corrections for those on probation and parole; and the implementation of the FAST unit, a joint fugitive apprehension unit of DPD and the Sheriff's Office, which apprehended nearly 1,000 individuals with outstanding felony warrants this year, prioritizing those wanted for gun crimes.”

The emphasis on reducing gun violence appears to be key to the success of this effort. Another key factor was in reducing the backlog of gun cases pending in the courts: “Felony gun cases pending trial in Wayne County Circuit Court have decreased from 4,000 in January 2022 to 1,330 in November 23, a 67% reduction, according to the coalition.”

When others have nothing but discouraging words for solving our gun violence epidemic, Kym Worthy, the Wayne County prosecutor is hopeful:  “This collaboration is unique in that issues are identified, solutions discussed, and these solutions are implemented. It is not just talk, talk, talk.”

The emergency preparedness project from the National Council on Severe Autism

This is from the National Council on Severe Autism with suggestions to get families thinking about emergency preparedness before it is too late:

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The Annual September 26th Project for 2022 Has Launched — Watch and Share 

September 13, 2022

Dear friends in the autism and special needs community, 

Last year we launched The September 26th Project, the annual emergency preparedness reminder for our families, created in commemoration of Feda Almaliti, founding VP of NCSA, and her son Muhammed, who died senselessly in a house fire on September 26, 2020, and embracing all who have faced such tragedies.

This September we again urge all autism and special needs families to take just 10 minutes on or around September 26th, to take steps to prepare for crisis and emergency. We are not asking for perfection, but for just one or two things that may help avert disaster. Don’t have a fire extinguisher? Now is the time to buy one. Haven’t checked your smoke/CO alarms? September is the perfect time to do it. Haven’t created a family emergency and exit plan? Go for it. Install a keypad lock where it would be helpful and safe. Or register with your local first responders, or create an emergency kit, charge back-up batteries, or attend a CPR class. Just one or two things, each step when taken year after year will make a big difference.

To get started, please watch (and share!) our 2022 September 26th Project video, where autism families who have suffered horrific tragedy share their stories — but also inspire you to take action, just 10 minutes, this September.

With best wishes,

The September 26th Project Committee

Maysoon Salah, Jill Escher, Kelly Bermingham, Lubna Salah

 

Michigan 2019: Tackling water contamination

An article from Mlive.com, "State employees required to report health, safety threats in Gov. Whitmer’s first executive directive" by Emily Lawler, 1/2/19, reports on the new Governor's first executive directive of her administration that begins to tackle the problem of water contamination in Michigan.

Governor Gretchen Whitmer signed her first executive order on 1/2/19 establishing a chain of command for state employees to report threats to public health and safety. 

"'The people of Michigan deserve to know that their government is working for them, and our government employees deserve to know that they can speak up when they see threats to Michigan’s health and safety,' Whitmer said before signing her first executive order."

The order was in part a response to the Flint water crisis where a state-appointed emergency manager failed to act to protect the city against lead contamination of its water supply. 

Another worrisome source of water contamination in Michigan was covered by Garrett Ellison on Mlive.com, "Major warning about Michigan PFAS crisis came 6 years ago" on 7/12/18. PFAS (Per- and polyfluoroalkyl substances) have been found in Michigan waterways and drinking water supplies. Robert Delaney, a veteran geologist at the Department of Environmental Quality “..took his concerns about per- and polyfluoroalkyl substances, or PFAS, to state environmental leaders more than six years ago in a prophetic report that called for decisive action on a looming health crisis…His alarm bell was largely ignored.” 

“‘Communities with fire training facilities, other Department of Defense (DOD) bases, metal platers, other major airports, major transportation corridors, and other industrialized areas all could have extensive contamination by (PFAS),’ Delaney wrote.”

“…nearly six years after Delaney's warning about the dangers and potential ubiquity of PFAS, his predictions are coming true. Numerous sites around Michigan have known PFAS plumes and the list keeps growing as testing and attention escalates. So far, the number is 31 and counting across 15 communities, where neighbors are questioning whether contaminated water is to blame for chronic diseases.” 

A few months ago we began seeing signs along our beloved Huron River warning us not to eat the fish. And that white foam that we see on the banks from time to time may be related to PFAs.

Among the sources of contamination are fire retardents, food packaging materials, numerous household products, and drinking water.

“Following an October 2010 presentation on PFAS to the EPA, Department of Defense and an interstate regulatory group, Delaney wrote that his talk was 'well received, if you consider stunned silence a good reception.'" 

There is more information on PFAS from the US Environmental Protection Agency (EPA) Website :

“…Studies indicate that PFOA and PFOS can cause reproductive and developmental, liver and kidney, and immunological effects in laboratory animals. Both chemicals have caused tumors in animals. The most consistent findings are increased cholesterol levels among exposed populations, with more limited findings related to:

• low infant birth weights, 
• effects on the immune system, 
• cancer (for PFOA), and 
• thyroid hormone disruption (for PFOS). "

Finding and reporting on sites of contamination are the first step in protecting citizens against the effects of PFAS. This is especially important in light of the apparent attempt to suppress Delaney's 2012 report and restricting Delaney's access to news media:

"Although Delaney has been a regularly accessible expert on PFAS contamination in Michigan, his freedom to speak with news media was curtailed at DEQ last fall [2017] after he talked about the report on the radio. The agency would not make him available for this story despite multiple requests over several months.

Requiring state officials to warn the public about risks to health and safety should have gone without saying, but the Governor’s first executive directive removes any ambiguity on this issue.

Project TENDR: Targeting Environmental Neuro-Developmental Risks

A consensus statement  from Project TENDR, "Targeting Environmental Neuro-Developmental Risks" was published in Environmental Health Perspectives, Volume 124/Issue 7/July 2016. The following is from the summary with additional excerpts from the consensus statement:

"...Leading scientific and medical experts, along with children’s health advocates, came together in 2015 under the auspices of Project TENDR: Targeting Environmental Neuro-Developmental Risks to issue a call to action to reduce widespread exposures to chemicals that interfere with fetal and children’s brain development. Based on the available scientific evidence, the TENDR authors have identified prime examples of toxic chemicals and pollutants that increase children’s risks for neurodevelopmental disorders. These include chemicals that are used extensively in consumer products and that have become widespread in the environment. Some are chemicals to which children and pregnant women are regularly exposed, and they are detected in the bodies of virtually all Americans in national surveys conducted by the U.S. Centers for Disease Control and Prevention. The vast majority of chemicals in industrial and consumer products undergo almost no testing for developmental neurotoxicity or other health effects….This consensus statement lays the foundation for developing recommendations to monitor, assess, and reduce exposures to neurotoxic chemicals. These measures are urgently needed if we are to protect healthy brain development so that current and future generations can reach their fullest potential."

A Call to Action

“The TENDR Consensus Statement is a call to action to reduce exposures to toxic chemicals that can contribute to the prevalence of neurodevelopmental disabilities in America’s children. The TENDR authors agree that widespread exposures to toxic chemicals in our air, water, food, soil, and consumer products can increase the risks for cognitive, behavioral, or social impairment, as well as specific neurodevelopmental disorders such as autism and attention deficit hyperactivity disorder (ADHD) …This preventable threat results from a failure of our industrial and consumer markets and regulatory systems to protect the developing brain from toxic chemicals. To lower children’s risks for developing neurodevelopmental disorders, policies and actions are urgently needed to eliminate or significantly reduce exposures to these chemicals. …”

Majority of Chemicals Untested for Neurodevelopmental Effects

“...Only a minority of chemicals has been evaluated for neurotoxic effects in adults. Even fewer have been evaluated for potential effects on brain development in children …Further, toxicological studies and regulatory evaluation seldom address combined effects of chemical mixtures, despite evidence that all people are exposed to dozens of chemicals at any given time.”

Need for a New Approach to Evaluating Evidence

"...Some chemicals, like those that disrupt the endocrine system, present a concern because they interfere with the activity of endogenous hormones that are essential for healthy brain development. Endocrine-disrupting hormones (EDCs) that are essential for healthy brain development include many pesticides, flame retardants, fuels, and plasticizers. One class of EDCs that is ubiquitous in consumer products are the phthalates. These are an emerging concern for interference with brain development and therefore demand attention..."

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Environmental Health Perspectives  (ISSN-L 0091-6765) is a monthly peer-reviewed journal of research and news published with support from the National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health, U.S. Department of Health and Human Services.

Conflicting regulations on contamination endanger public health

Since the country has been made aware of the poisoning of the Flint Michigan water supply with lead from corroded pipes, stories about lead contamination have been popping up everywhere. The danger with this is that the public becomes numb to the consequences of water contamination and the problem seems too big to solve. We throw up our hands and check off another reason to distrust government solutions to big problems.

The fact is that the old lead pipes in Flint can be replaced and should be, starting now. It will be a long and expensive slog to correct the problem and there may not be any way to make the children exposed to lead poisoning completely whole again, but we have to start somewhere. Despair is not a solution.

An op-ed in the New York Times, “Blame HUD for America’s Lead Epidemic” by Emily Benfer, 3/4/16, exposes conflicting federal regulations that have resulted in the acceptance of high levels of lead exposure for residents of public housing.

According to Benfer, the standards for public housing from the Department of Housing and Urban Development (HUD) sets the level that defines lead poisoning three to four times higher than that set by the Centers for Disease Contol and Prevention (CDC): “While the C.D.C. recommends intervention for lead poisoning at 5 micrograms per deciliter, HUD regulations do not call for action until after a child’s blood lead level is 20 micrograms per deciliter, or 15 to 19 micrograms per deciliter over three months — levels that cause severe and permanent brain damage.”

She continues: “These regulations are the most egregious contributors to the epidemic of lead poisoning in public and low-income housing. I have spent six years working with Loyola University Chicago law students, the Erie Family Health Center and civil legal aid organizations on cases involving low-income families living in unhealthy housing. We have seen firsthand how chipping, cracking lead paint creates toxic living conditions.”

The solution to this problems is within reach of us mere mortals by getting Congress and federal regulatory agencies to bring standards into alignment and start correcting the problem that causes children to suffer from our neglect. 

In another regulatory mismatch much closer to home, the conflict between standards for dioxane contamination in groundwater between the State of Michigan and the federal Environmental Protection Agency has resulted in children and their families being exposed to unacceptably high levels of a carcinogen because the state failed to correct its standards for groundwater contamination to conform with the EPA. 

An article in the Ann Arbor News, “Family with poisoned well finally getting municipal water services”, by Ryan Stanton, 3/4/16, describes the plight of a family that has been using contaminated well water for over two years because they were assured by the Pall Corp. that took over ownership of the company that originally caused the contamination,  that “the water was safe to drink with dioxane concentrations at 17 parts per billion because it's below the state's 85 ppb standard.” They were not told, however, that the federal EPA standard shows that dioxane at 3.5 ppb in drinking water poses a 1 in 100,000 cancer risk, the standard that the state sets at 85 ppb. 

According to the article, “local officials have been fighting for years to convince the state to move to a stricter standard to reflect the latest findings about dioxane published by the U.S. Environmental Protection Agency in 2010. The DEQ [Department of Environmental Quality] was required by law to update the standards by December 2013, but Lansing politics and technical problems have been blamed for repeated delays and missed deadlines.”

State officials acknowledge the problem and “the Michigan Department Environmental Quality is proposing to move to a single-digit standard sometime this year.”
 
The Pate family that has been living with dioxane-contaminated well water has retained an attorney.

Heather Pate is quoted in the article: "Too many times politicians get away with stuff… They're not going to get away with this one. We're not going to let it happen. And we're not doing this for money. I want them in prison. I want them doing time."

This sounds about right to me.

The Flint Water Crisis : All of Flint's children should be assumed to have been exposed to lead

I have already heard people trying to downplay the Flint water crisis by saying that the lead poisoning wasn't as bad as reported or that the city is responsible for this because it did not manage its budget properly. When Flint changed its water supply in April 2014 under an emergency manager who was brought in to resolve the financial crisis in the city, the people in charge decided to save a little money by not adding phosphate to the Flint River water. Phosphate prevents the corrosion of old pipes that otherwise leach lead into the water supply and would have prevented the disaster that followed.

A recent article in the Detroit Free Press "All Flint's children must be treated as exposed to lead" by Kristi Tanner, 1/16/16, includes these recommendations to the State: 
 
"In recommendations to the state on Monday, Dr. Mona Hanna-Attisha said all kids under the age of 6 should be treated with some kind of prevention actions.

"Eden Wells, the state's chief medical executive, said Monday that all children who drank the city's water since April 2014 have been exposed to lead. 'It is important when we think about a public health perspective that we consider the whole cohort ... exposed to the drinking water, especially 6 years and under since April 2014,  as exposed, regardless of what their blood level is on Jan. 11.'

"The state's most recent report, based on  tests conducted between October and December 2015, shows that 43 people — only a small portion of the number exposed — had elevated blood lead levels. That's because these tests measure only the amount of lead in a person's blood, which decreases after about 30 days, according to the U.S. Centers for Disease Control and Prevention."

See video here from CNN.

Kentucky: New regs require national background checks for employees caring for vulnerable populations

 See Update below!

This is a press release from the office of Governor Beshear of Kentucky:

Commonwealth of Kentucky
Office of the Governor
FOR IMMEDIATE RELEASE

Contact:
Terry Sebastian
502.564.2611
502.229.6130

Jennifer Brislin
502.564.2611
502.753.9766

Gov. Beshear Implements Mandatory National Background Checks for Nursing Home Employees, Others Caring for Kentucky’s Most Vulnerable Adults 

FRANKFORT, Ky. (Nov. 20, 2015) – Governor Steve Beshear today announced that he has signed an emergency regulation requiring certain health care providers to obtain national criminal background checks on new employees and other individuals who provide direct one-on-one care to elderly residents or patients in order to obtain or renew the facility’s license to operate in the Commonwealth.

Effective Jan. 1, 2016, approximately 1,300 providers will be required to obtain national background checks for all new employees. These providers include nursing homes, intermediate care facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID); adult day health care programs; assisted living communities; home health agencies; hospice; personal services agencies; providers of home and community-based services; personal care homes; and staffing agencies, including nursing pools that have contracts to provide staff to one or more of the listed employer types.

“Protecting the elderly and other individuals residing in these facilities is not only important – it is our duty as state leaders,” said Gov. Beshear. “All too often, these vulnerable citizens become victims of the very individuals who are supposed to be caring for them. This regulation, based upon a federal law allowing these background checks, will ensure we are able to thoroughly track the history of anyone who has committed such an offense, whether it occurred in Kentucky or out of state, and ensure they will not be working at health care facilities in the Commonwealth.”

Prior to utilizing this federal law, state law required only name-based, Kentucky-specific background checks, creating a loophole that allowed applicants seeking employment in these long-term care and other settings to hide criminal actions committed in other states. Meanwhile, the prevalence of alleged abuse or exploitation of seniors in these settings remained significant. Since May 2014, more than 2,600 total complaints have been lodged against long-term care providers, nearly 30 percent of which were directly related to suspected abuse or exploitation of residents.

“By requiring fingerprint-supported background checks that search for both state and federal FBI criminal records, applicants will not be able to hide criminal actions committed in other states,” said Cabinet for Health and Family Services Secretary Audrey Tayse Haynes. “National background checks are a critical initiative that dramatically improve the ability of long-term care and other providers to timely and accurately research the backgrounds of potential employees, ruling out individuals with histories of violence, abuse or exploitation that occurred in other states.”

Since receiving an initial federal grant in 2011 from the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), the Cabinet for Health and Family Services (CHFS) Office of Inspector General implemented the Kentucky Applicant Registry and Employment Screening background check program, also known as KARES, and offered the statewide program on a voluntary basis with 35 fingerprint scanners located in Kentucky.

KARES was recently awarded an additional $689,000 in CMS grant funding to add 35 more fingerprint scanners throughout Kentucky, bringing the total number of scanner locations to 70.

“This program improves resident and patient safety and promotes a higher quality of care,” said CHFS Inspector General Maryellen Mynear. “The electronic program has now been fully tested by voluntary participants over the last 18 months, and the feedback has been overwhelmingly positive regarding its ease of use, cost effectiveness and speed. Our office will assist providers as they apply for initial licensure or renew their existing license to ensure a smooth and timely transition to a national criminal background check program that meets the requirements of this regulation.”

In signing the regulation, Gov.  Beshear noted the success of KARES. The electronic program has been operational since May 2014 on a voluntary basis and allows employers to perform all necessary background checks – from professional licenses to abuse registries to both state and federal criminal databases – in one step through electronic fingerprinting.  The program significantly reduces the time required to complete a background check, and in most cases returns results in 24 to 72 hours, compared to three or more weeks using the traditional paper-based background check process.

“I’m glad we are taking this step to protect Kentucky’s seniors,” said Rep. David Watkins, of Henderson.  “Those being cared for or recovering in long-term care facilities need as many protections as we can provide. This system will help make sure those seeking employment caring for our loved ones don’t slip through the cracks between law enforcement agencies and have been thoroughly checked out.”

“This is an important step in protecting our loved ones in care facilities,” said Rep. Linda Belcher, of Shepherdsville. “I have been working on legislation to accomplish this for some time now and am very pleased Gov. Beshear has taken this step to further protect the elderly residents and patients.”

“Our senior citizens and our disabled citizens are especially vulnerable to abuse and it is up to us to protect them,” said Sen. Denise Harper Angel, of Louisville.  “As a legislator, I have been committed to putting in place stronger safeguards to protect our most at-risk citizens. I am pleased that Gov. Beshear is implementing mandatory national background checks for nursing home employees and other caregivers – legislation that I have long been an advocate.”

“I commend Gov. Steve Beshear for this action to provide protections for our senior citizens,” said Sen. Tom Buford, of Nicholasville.

Kentucky State Police Commissioner Rodney Brewer said KSP maintains the criminal history repository on behalf of the Commonwealth and has partnered with CHFS to provide pertinent information for this initiative.

“The KARES program is an excellent example of state government agencies working together to safeguard Kentucky’s elderly citizens,” Commissioner Brewer said.  “We will utilize technology in any way possible to deliver real-time information for citizens who are vulnerable to abuse due to age and medical issues.”
 
Since its launch, the program has performed more than 2,200 background checks and has screened out applicants who had been convicted of serious violent offenses in other states but had no criminal history in Kentucky.

The program’s website is found at http://chfs.ky.gov/os/oig/kares/ and contains provider enrollment information, general information for both providers and the public, frequently asked questions and links to related programs and content. Additional information can be obtained by contacting the program’s help service via email, KARES.Helpdesk@ky.gov or by telephone at 502-564-2159.

[Gov. Beshear’s press releases are available on his official website at www.governor.ky.gov]

Update: December 4, 2015
 
From the VOR Weekly News Update for November 27, 2015: 

Governor-Elect Bevin takes office on December 8th. You have an opportunity to speak to his transition team and let them know you want him and his administration to support mandatory national background checks for state caregivers working in nursing homes, intermediate care facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID); adult day health care programs; assisted living communities; home health agencies; hospice; personal services agencies; providers of home and community-based services; personal care homes; and staffing agencies, including nursing pools that have contracts to provide staff to one or more of the listed employer types.
  
To support the continuation of these regulations, use the sample message below to create your own message to the transition term preferably before December 8th.

Email Address of Transition Team:  freshstart@bevintransition.com

SAMPLE SUBJECT:
Support Mandatory National Background Checks for Nursing Home Employees and Others Caring for Kentucky’s Most Vulnerable Adults

SAMPLE MESSAGE:
Dear Bevin Transition Team,

We ask for your full support for the emergency and the companion administrative regulation that beginning on January 1, 2016 provides the mandatory protection of the KARES program to thousands of Kentucky’s most vulnerable citizens including our XXX (son, daughter, brother , sister, cousin, friend) .

Add any personal information like : Our XXX is unable to report acts of abuse, negligence or exploitation.

Sincerely,

Name(s)
Address
City, State, Zip
Phone

If you are not from Kentucky, you can still help. Write the governor-elect and tell them how mandatory background checks have helped in your state, and make it clear how vulnerable the I/DD population is.

If you would, please BCC: info@vor.net with your response!
 

When more costs less: more and better psychiatric care reduces overall costs

An opinion piece in the New York Times, (8/3/13) by Christine Montross entitled "The Woman Who Ate Cutlery" illustrates the point that trying to save money by making care and treatment for people with mental illness less accessible, does not save anything. Emergency rooms become the only available treatment venue in a crisis - a poor substitute for preventive care before a crisis develops, hospitalizations increase, and sometimes lives are lost.

Problems in the the system of care for people with mental illness often parallel those for people with developmental disabilities. There are many people with developmental disabilities who have unusual and sometimes dangerous behaviors, with the added complication that the person's capacity to communicate their frustrations make it even more difficult to know how to relieve their distress. There are also people with DD whose medical problems, when not addressed early or treated appropriately, can land them in the emergency department with the result that the person receives too little or too much treatment that is almost always more costly than it needs to be.

In "The Woman Who Ate Cutlery", "M" is an extreme case - a woman who ingests knives and forks and other sharp objects and inserts objects and substances into her body to relieve stress caused by mental illness. 

According to the article:

• "If M had insurance, or enough money to pay out of pocket, she might see a therapist every week for an hour and a psychiatrist once or twice a month. Instead, she’s treated by an overextended, publicly funded mental-health center where she sees a psychiatrist for 20 minutes, four times a year. Not surprisingly, her symptoms persist and she is hospitalized again and again."
• "…Our failure to provide a critical, basic level of outpatient psychiatric care to the mentally ill creates a volatile cycle in which uninsured or underinsured patients avail themselves of treatment only when they are in crisis. This is analogous to refusing to treat hypertensive patients — or to monitor their blood pressure — unless they show up in the E.R. after having had a stroke."
• "…If M had a regular outpatient psychiatrist, she could call him or her in these moments of distress, schedule an urgent appointment, and obtain treatment and care from a simple phone call. But M does not have a relationship with a provider; she has a relationship with an institution. And the institution requires that M be in imminent danger in order to be treated."
• "…According to Dr. E. Fuller Torrey, president of the national nonprofit Treatment Advocacy Center, 'Assisted outpatient treatment has proven to reduce psychiatric hospitalizations by more than 70 percent.'"

Montross concludes, "…we will need to place new societal value on the importance of mental health. Until accessible, affordable mental-health care is a universal right, too many psychiatric patients will continue to receive the reactionary, crisis-driven care that is all our emergency rooms are equipped to provide."

Lead poisoning in Detroit public school students linked to lower test scores

An article in the Detroit Free Press, "High lead poisoning linked to lower test scores in DPS" by Keith Matheny from 2/25/13, reports on research that matches blood test results for lead in 21,000 Detroit Public School students with those students' elementary and middle school standardized test scores:

"Children with lead at 2 to 5 micrograms per deciliter in their blood -- equal to or below stricter levels of concern set by the federal Centers for Disease Control and Prevention last year -- had a 33% higher likelihood of poor academic performance, said Harolyn Baker, a coauthor of the study and director of epidemiology at the nonprofit Michigan Healthcare Quality Improvement Organization.

"Students with blood lead levels greater than 5 micrograms per deciliter have a 50% chance of doing poorly on MEAP [Michigan Educational Assessment Program] tests, the study found."

Researchers factored out other possible causes of poor test performance related to maternal education, socioeconomic status, race, and gender to make sure that what researchers were seeing was related to lead levels in the blood. "The study updates research highlighted in-depth in the Free Press in 2010. That report found that of 39,199 DPS students tested as young children, only 23 had no lead in their bodies."
 
Here is a link to The DD News Blog post from May 2010 on the earlier study.

How far have we come in preventing disabilities in Preemies?

The answer is mixed, according to an article in Disability Scoop, "Despite Advances, Many Preemies Still Face Severe Disabilities" by Michelle Diament, 12/11/12.

Neither one of my sons' disabilities were caused by prematurity. Although they both survived because of care given to them in intensive care neonatal nurseries, that care was not enough to spare them from lives with profound mental and physical disabilities.

After Danny was born in 1976, I used to see photographs and news stories about premature infants and others who had survived and thrived after overcoming extremely difficult circumstances at the time of birth. I noticed one day at the hospital where Danny was born - I think we were making one of our treks to see his orthopedic surgeon - a bulletin board full of photographs from a recent reunion of "graduates" from the neonatal intensive care unit. Hmm?, I thought. We weren't invited. (You see how petty I can be when it comes to a perceived insult to a child of mine.)

Among the children at the reunion, not one was in a wheelchair. One wore glasses but otherwise there were no visible signs that any of them had significant disabilities. In the crowd I hung out with, mostly parents whose children were similar to Danny, many of those children had done time in the same neonatal intensive care nursery. I have no idea if there was any deliberate plot to exclude children like mine from the reunion party - maybe their parents were too tired or just didn't feel like celebrating. But since then, I have always been somewhat skeptical about claims that we are making tremendous progress in preventing and treating severe disabilities.

The Disability Scoop article sites two British studies. One concludes that, "Survival of babies born between 22 and 25 weeks’ gestation has increased since 1995 but the pattern of major neonatal morbidity [the incidence or prevalence of disease in a population] and the proportion of survivors affected are unchanged. These observations reflect an important increase in the number of preterm survivors at risk of later health problems."  Another, in comparing outcomes between 1995 and 2006, concludes that "At follow-up the findings are mixed: there is some evidence of improvement in the proportion of babies who survive without disability, an improvement in developmental scores, and a reduction in associated neuromorbidity (seizures and shunted hydrocephalus), but no change in the rate of severe impairment."

Overall, there are more preemies who survive without any disability, and good for them, but the proportion of those with severe disability has remained the same.

Michigan's repeal of motorcycle helmet law leads to more deaths and incapacitating injuries

This is from an article at MLive, "Analysis: Motorcycle helmet use falls, injury rate climbs since law change" by Jonathan Oosting, 7/19/12. It shows the evidence so far, that Michigan's repeal of its motorcycle helmet law has caused more deaths and incapacitating injuries (i.e. disabilities) for motorcycle riders not wearing helmets.

The good news is that at least for the first two months after the law was repealed, 80% of riders involved in a crash continued to wear helmets. For the third month, that figure dropped to 68%. According to the article, a spokeswoman for the insurance company State Farm of Michigan said the findings were consistent with a National Highway Traffic Safety Administration report.

Preventing abuse with background checks

A small item in today's AnnArbor.com caught my attention as an easy topic for a short blogpost: Michigan's Governor Rick Snyder signed into law two state Senate bills, SB 787 and SB 788, that "amend existing statute to require that criminal background checks are done through the FBI for owners, operators, and certain other workers in adult foster care homes and homes for the elderly." A person who has been found guilty of a felony or who has been found guilty of a misdemeanor in the last ten years for the crime of abuse of a vulnerable adult can be denied a license.  

“We have a responsibility to ensure the best and safest care for Michigan’s elderly,” Snyder said in a statement. “A thorough background check of caregivers ensures only the most dedicated and scrupulous Michiganders work with our vulnerable citizens.”

Here is a brief summary of the bills. The law requires state background checks through the state police, as well as the FBI.

This one little article brings up a lot of questions that I am embarrassed to say I don't have answers for: Does the state require background checks for all direct care workers who work in these homes? What about the proliferation of unlicensed settings where people with developmental disabilities receive care and other services? Are agencies or individuals who provide care in these settings subject to background checks? Are there requirements that local Community Mental Health agencies do background checks on caregivers and others who interact with the DD population? The purpose of background checks is to prevent abuse, but do the laws extend far enough to have a significant effect?
 
I can see I have my work cut out for me. Abuse of severely developmentally disabled adults like my sons is a real and justified fear. At least I know this: it is a crime to abuse a vulnerable adult, "an individual age 18 or over who, because of age, developmental disability, mental illness, or physical disability requires supervision or personal care or lacks the personal and social skills required to live independently." This applies to any caregiver no matter the setting. Anyone found to have abused a vulnerable adult can face criminal penalties including prison and stiff fines. Here is the statute:

THE MICHIGAN PENAL CODE (EXCERPT)
Act 328 of 1931
 

750.145n Vulnerable adult abuse; first degree; second degree; third degree; fourth degree; authority to prevent vulnerable adult from being harmed or harming others not prohibited; applicability of section to act carried out by patient advocate.
Sec. 145n.
(1) A caregiver is guilty of vulnerable adult abuse in the first degree if the caregiver intentionally causes serious physical harm or serious mental harm to a vulnerable adult. Vulnerable adult abuse in the first degree is a felony punishable by imprisonment for not more than 15 years or a fine of not more than $10,000.00, or both.
(2) A caregiver or other person with authority over the vulnerable adult is guilty of vulnerable adult abuse in the second degree if the reckless act or reckless failure to act of the caregiver or other person with authority over the vulnerable adult causes serious physical harm or serious mental harm to a vulnerable adult. Vulnerable adult abuse in the second degree is a felony punishable by imprisonment for not more than 4 years or a fine of not more than $5,000.00, or both.
(3) A caregiver is guilty of vulnerable adult abuse in the third degree if the caregiver intentionally causes physical harm to a vulnerable adult. Vulnerable adult abuse in the third degree is a misdemeanor punishable by imprisonment for not more than 2 years or a fine of not more than $2,500.00, or both.
(4) A caregiver or other person with authority over the vulnerable adult is guilty of vulnerable adult abuse in the fourth degree if the reckless act or reckless failure to act of the caregiver or other person with authority over a vulnerable adult causes physical harm to a vulnerable adult. Vulnerable adult abuse in the fourth degree is a misdemeanor punishable by imprisonment for not more than 1 year or a fine of not more than $1,000.00, or both.
(5) This section does not prohibit a caregiver or other person with authority over a vulnerable adult from taking reasonable action to prevent a vulnerable adult from being harmed or from harming others.
(6) This section does not apply to an act or failure to act that is carried out as directed by a patient advocate under a patient advocate designation executed in accordance with sections 5506 to 5515 of the estates and protected individuals code, 1998 PA 386, MCL 700.5506 to 700.5515.

A drug to prevent premature birth priced out of reach for most women?

[Premature birth is a significant risk factor for cerebral palsy and other disabilities]

The Detroit Free Press featured an article on March 21, 2011, (Drug price for a safe pregnancy: $30,000 by DFP medical writer Patricia Anstett) about a drug that has been effective in reducing premature births and has been available for pregnant women since 2003. The cost has been $200 for a regimen of 20 injections.

The Federal Drug Administration has granted final approval for Maken, the brand name of the drug that is now produced exclusively by Ther-Rx, a subsidiary of K-V Pharmaceutical of St. Louis. The drug has been designated an orphan drug (benefitting fewer than 200,000 people) which gives special incentives so that the drug company can make money on it. A regimen of 20 injections will now cost $30,000.

The pharmaceutical company has created a financial aid program to help poor women get the drug for free and others to obtain discounts, but the high price may deter Medicaid from paying for the drug and generally reduce access to the drug by pregnant women who need it.

The Website "A Healthier Michigan", sponsored by Blue Cross Blue Shield of Michigan, posts an article, Inflated Drug Price Lands Pharma Company in Social Media Crisis, discussing the PR problems the drug company is facing with the launching of a facebook page opposing the exorbitant price increase.

More background on the story is available in an article from the St. Louis Dispatch from March 10, 2011. It turns out the company that has exclusive rights to market the drug did not invent it. The new cost of the drug will make it more expensive to use the drug to prevent premature births than to not treat women and pay the added costs of the premature births that will occur.

Just one more clue as to why health care costs are so high.

Startling lead levels for students in Detroit schools

Several articles in Sunday's Detroit Free Press, May 16, 2010, cover startling new findings about the level of lead in Detroit public school students and the correlation of lead levels with lower IQ's and test scores.

Lead contamination is found in older homes with lead-based paint in paint chips, dust, and soil. It is also found in lead pipes or faucets, some toys and pottery glazes, and dollar-store jewelry. Although there is no safe level of lead, a blood level of 5-9 micrograms per deciliter and above is considered to be lead poisoning. Its affects are most harmful in children under 6 years old. Lead poisoning shows up as learning problems, hyperactivity, and problems with reading, memory, and paying attention. There are ways to make the problem better with a stimulating environment and a healthy diet.

In a study by the Detroit Public Schools and the city health department, 58% of about 39,000 children tested had a history of lead poisoning. 60% of students who performed below grade level on 2008 standardized tests had elevated lead levels. 30 Detroit elementary schools had at least 35% of the student population with 5 micrograms of lead or more. The figure is likely far higher because half the children had no record of lead tests. Kids in special education had higher lead levels.

Links to the Detroit Free Press articles:

• High lead levels hurt learning for DPS kids
• DPS lead poisoning by school
• Carsten's tackles effects of lead head-on
• Lead poisoning help, resources
• Interactive map shows lead levels in neighborhoods

Flu shots benefit pregnant women and their babies

Two new studies show that pregnant women who are given flu shots during their pregnancy can reduce the risk of having children born prematurely or with low birth rate. [The studies did not include women vaccinated for the H1N1 (swine flu) virus.]

An article in Science News, November 21, 2009, entitled Flu shots for moms-to-be benefit babies, reports on research conducted in Georgia and Bangladesh.

Saad Omer of Emory University in Atlanta identified over 4,000 pregnant women of whom 15% had received a flu shot. Those who received the flu shot were overall 40% less likely to have a baby born prematurely and 70% less likely to have a premature baby if the mother received a flu shot during peak flu season.

The second study was conducted by Mark Steinhoff at Cincinnati Children’s Hospital Medical Center and a Bangladeshi team. They found that babies born to flu-vaccinated women in Bangladesh were less likely to get the flu in their first year of life. On average, women who didn’t get flu shots gave birth to babies weighing about a half-pound less than those born to women getting the shot.

The article goes on to say that flu vaccination rates in the United States are "dismal". Only 15 -21% of pregnant women receive flu shots during flu season.