Workers Filed More Than 4,100 Complaints About Protective Gear. Some Still Died.

COVID-19 cases were climbing at Michigan’s McLaren Flint hospital. So Roger Liddell, 64, who procured supplies for the hospital, asked for an N95 respirator for his own protection, since his work brought him into the same room as COVID-positive patients.

But the hospital denied his request, said Kelly Indish, president of the American Federation of State, County and Municipal Employees Local 875.

On March 30, Liddell posted on Facebook that he had worked the previous week in both the critical care unit and the ICU and had contracted the virus. “Pray for me God is still in control,” he wrote. He died April 10.

Roger Liddell(Courtesy of Bill Sohmer)

The hospital’s problems with personal protective equipment (PPE) were well documented. In mid-March, the state office of the Occupational Safety and Health Administration (OSHA) received five complaints, which described employees receiving “zero PPE.” The cases were closed April 21, after the hospital presented paperwork saying problems had been resolved. There was no onsite inspection, and the hospital’s written response was deemed sufficient to close the complaints, a local OSHA spokesperson confirmed.

The grief and fear gripping workers and their families reflect a far larger pattern. Since March, more than 4,100 COVID-related complaints regarding health care facilities have poured into the nation’s network of federal and state OSHA offices, which are tasked with protecting workers from harm on the job.

A KHN investigation found that at least 35 health care workers died after OSHA received safety complaints about their workplaces. Yet by June 21, the agency had quietly closed almost all of those complaints, and none of them led to a citation or a fine.

The complaint logs, which have been made public, show thousands of desperate pleas from workers seeking better protective gear for their hospitals, medical offices and nursing homes.

The quick closure of complaints underscores the Trump administration’s hands-off approach to oversight, said former OSHA official Deborah Berkowitz. Instead of cracking down, the agency simply sent letters reminding employers to follow Centers for Disease Control and Prevention guidelines, said Berkowitz, now a director at the National Employment Law Project.

“This is a travesty,” she said.

A third of the health care-related COVID-19 complaints, about 1,300, remain open and about 275 fatality investigations are ongoing.

During a June 9 legislative hearing, Labor Secretary Eugene Scalia said OSHA had issued one coronavirus-related citation for violating federal standards. A Georgia nursing home was fined $3,900 for failing to report worker hospitalizations on time, OSHA’s records show.

“We have a number of cases we are investigating,” Scalia said at the Senate Finance Committee hearing. “If we find violations, we will certainly not hesitate to bring a case.”

Texts between Barbara Birchenough and her daughter, (in blue) Kristin Carbone.(Courtesy of Kristin Carbone)

A March 16 complaint regarding Clara Maass Medical Center in Belleville, New Jersey, illustrates the life-or-death stakes for workers on the front lines. The complaint says workers were “not allowed to wear” masks in the hallway outside COVID-19 patients’ rooms even though studies have since shown the highly contagious virus can spread throughout a health care facility. It also said workers “were not allowed adequate access” to PPE.

Nine days later, veteran Clara Maass registered nurse Barbara Birchenough texted her daughter: “The ICU nurses were making gowns out of garbage bags. … Dad is going to pick up large garbage bags for me just in case.”

Kristin Carbone, the eldest of four, said her mother was not working in a COVID area but was upset that patients with suspicious symptoms were under her care.

In a text later that day, Birchenough admitted: “I have a cough and a headache … we were exposed to six patients who we are now testing for COVID 19. They all of a sudden got coughs and fevers.”

“Please pray for all health care workers,” the text went on. “We are running out of supplies.”

By April 15, Birchenough, 65, had died of the virus. “They were not protecting their employees in my opinion,” Carbone said. “It’s beyond sad, but then I go to a different place where I’m infuriated.”

OSHA records show six investigations into a fatality or cluster of worker hospitalizations at the hospital. A Labor Department spokesperson said the initial complaints about Clara Maass remain open and did not explain why they continue to appear on a “closed” case list.

Nestor Bautista, 62, who worked closely with Birchenough, died of COVID-19 the same day as she did, according to Nestor’s sister, Cecilia Bautista. She said her brother, a nursing aide at Clara Maass for 24 years, was a quiet and devoted employee: “He was just work, work, work,” she said.

Barbara Birchenough(Courtesy of Kristin Carbone)

Nestor Bautista(Courtesy of Cecilia Bautista)

Responding to allegations in the OSHA complaint, Clara Maass Medical Center spokesperson Stacie Newton said the virus has “presented unprecedented challenges.”

“Although the source of the exposure has not been determined, several staff members” contracted the virus and “a few” have died, Newton said in an email. “Our staff has been in regular contact with OSHA, providing notifications and cooperating fully with all inquiries.”

Other complaints have been filed with OSHA offices across the U.S.

Twenty-one closed complaints alleged that workers faced threats of retaliation for actions such as speaking up about the lack of PPE. At a Delaware hospital, workers said they were not allowed to wear N95 masks, which protected them better than surgical masks, “for fear of termination or retaliation.” At an Atlanta hospital, workers said they were not provided proper PPE and were also threatened to be fired if they “raise[d] concerns about PPE when working with patients with Covid-19.”

Of the 4,100-plus complaints that flooded OSHA offices, over two-thirds are now marked as “closed” in an OSHA database. Among them was a complaint that staffers handling dead bodies in a small room off the lobby of a Manhattan nursing home weren’t given appropriate protective gear.

More than 100 of those cases were resolved within 10 days. One of those complaints said home health nurses in the Bronx were sent to treat COVID-19 patients without full protective gear. At a Massachusetts nursing home that housed COVID patients, staff members were asked to wash and reuse masks and disposable gloves, another complaint said. A complaint about an Ohio nursing home said workers were not required to wear protective equipment when caring for COVID patients. That complaint was closed three days after OSHA received it.

It remains unclear how OSHA resolved hundreds of the complaints. A Department of Labor spokesperson said in an email that some are closed based on an exchange of information between the employer and OSHA, and advised reporters to file Freedom of Information Act requests for details on others.

“The Department is committed to protecting America’s workers during the pandemic,” the Labor Department said in a statement. “OSHA has standards in place to protect employees, and employers who fail to take appropriate steps to protect their employees may be violating them.”

The agency advised its inspectors on May 19 to place reports of fatalities and imminent danger as a top priority, with a special focus on health care settings. Since late March, OSHA has opened more than 250 investigations into fatalities at health care facilities, government records show. Most of those cases are ongoing.

According to the mid-March complaints against McLaren Flint, workers did not receive needed N95 masks and “are not allowed to bring them from home.” They also said patients with COVID-19 were kept throughout the hospital.

Patrick Cain and his wife, Kate(Courtesy of Kelly Indish)

Filing complaints, though, did little for Liddell, or for his colleague, Patrick Cain, 52. After the complaints were filed, Cain, a registered nurse, was treating people still awaiting the results of COVID-19 diagnostic tests — potentially positive patients ― without an N95 respirator. He was also working outside a room where potential COVID-19 patients were undergoing treatments that research supported by the University of Nebraska has since shown can spread the virus widely in the air.

At the time, there was a debate over whether supply chain breakdowns of PPE and weakened CDC guidelines on protective gear were putting workers at risk.

Cain felt vulnerable working outside of rooms where COVID patients were undergoing infection-spreading treatments, he wrote in a text to Indish on March 26.

Texts between union president Kelly Indish and Patrick Cain (right)(Courtesy of Kelly Indish)

“McLaren screwed us,” he wrote.

He fell ill in mid-March and died April 4.

McLaren has since revised its face-covering policy to provide N95s or controlled air-purifying respirators (CAPRs) to workers on the COVID floor, union members said.

A spokesperson for the McLaren Health Care system said the OSHA complaints are “unsubstantiated” and that its protocols have consistently followed government guidelines. “We have always provided appropriate PPE and staff training that adheres to the evolving federal, state, and local PPE guidelines,” Brian Brown said in an email.

Separate from the closed complaints, OSHA investigations into Liddell and Cain’s deaths are ongoing, according to a spokesperson for the state’s Department of Labor and Economic Opportunity.

Nurses at Kaiser Permanente Fresno Medical Center also said the complaints they aired before a nurse’s death have not been resolved. (KHN is not affiliated with Kaiser Permanente.)

On March 18, nurses filed an initial complaint. They told OSHA they were given surgical masks, instead of N95s. Less than a week later, other complaints said staffers were forced to reuse those surgical masks and evaluate patients for COVID without wearing an N95 respirator.

Several nurses who cared for one patient who wasn’t initially suspected of having COVID-19 in mid-March wore no protective gear, according to Amy Arlund, a Kaiser Fresno nurse and board member of the National Nurses Organizing Committee board of directors. Sandra Oldfield, a 53-year-old RN, was among them.

Arlund said Oldfield had filed an internal complaint with management about inadequate PPE around that time. Arlund said the patient’s illness was difficult to pin down, so dozens of workers were exposed to him and 10 came down with COVID-19, including Oldfield.

Sandra Oldfield(Courtesy of Lori Rodriguez)

Lori Rodriguez, Oldfield’s sister, said Sandra was upset that the patient she cared for who ended up testing positive for COVID-19 hadn’t been screened earlier.

“I don’t want to see anyone else lose their life like my sister did,” she said. “It’s just not right.”

Wade Nogy, senior vice president and area manager of Kaiser Permanente Fresno, confirmed that Oldfield had exposure to a patient before COVID-19 was suspected. He said Kaiser Permanente “has years of experience managing highly infectious diseases, and we are safely treating patients who have been infected with this virus.”

Kaiser Permanente spokesperson Marc Brown said KP “responded to these complaints with information, documents and interviews that demonstrated we are in compliance with OSHA regulations to protect our employees.” He said the health system provides nurses and other staff “with the appropriate protective equipment.”

California OSHA officials said the initial complaints were accurate and the hospital was not in compliance with a state law requiring workers treating COVID patients to have respirators. However, the officials said the requirement had been waived due to global shortages.

Kaiser Fresno is now in compliance, Cal/OSHA said in a statement, but the agency has ongoing investigations at the facility.

Arlund said tension around protective gear remains high at the hospital. On each shift, she said, nurses must justify their need for a respirator, face shield or hair cap. She expressed surprise that the OSHA complaints were considered “closed.”

“I’m very concerned to hear they are closing cases when I know they haven’t reached out to front-line nurses,” Arlund said. “We do not consider any of them closed.”
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In Arizona Race, McSally Makes Health Care Pledge At Odds With Track Record

Of course I will always protect those with preexisting conditions. Always.

Trailing Democratic challenger Mark Kelly in one of the country’s most hotly contested Senate races, Arizona Sen. Martha McSally is seeking to tie herself to an issue with across-the-aisle appeal: insurance protections for people with preexisting health conditions.

 

“Of course I will always protect those with preexisting conditions. Always,” the Republican said in a TV ad released June 22.

The ad comes in response to criticisms by Kelly, who has highlighted McSally’s votes to undo the Affordable Care Act. That, he argued, would leave Americans with medical conditions vulnerable to higher-priced insurance.

The Arizona Senate race has attracted national attention and is considered a toss-up, though Kelly is leading in many polls. McSally’s attempt to present herself as a supporter of protecting people with preexisting conditions — a major component of the 2010 health law — is part of a larger pattern in which vulnerable Republican incumbents stake out positions advocating for this protection while also maintaining the GOP’s strong stance against the ACA.

McSally, who was appointed by the governor to take over John McCain’s Senate seat in 2019, used similar messaging in her failed 2018 bid for the state’s other Senate position. And President Donald Trump echoed the declaration at a June 23 rally in Phoenix, saying McSally — along with the rest of the Republican Party — “will always protect people with preexisting conditions.”

With that in mind, we decided to take a closer look. We contacted McSally’s campaign, which cited her support of a different piece of legislation, the Protect Act. But independent experts told us that legislation doesn’t satisfy the standard she sets out.

Past and Present

Only one national law makes sure people with preexisting medical conditions don’t face discrimination or higher prices from insurers. It’s the Affordable Care Act.

Both as a member of the House of Representatives and as a senator, McSally has supported efforts to undo the health law — voting in 2015 to repeal it and in 2017 to replace it with the Republican-backed American Health Care Act, which would have permitted insurers to charge higher premiums for people with complicated medical histories.

“Anyone who voted for that bill was voting to take away the ACA’s preexisting condition protections,” said Jonathan Oberlander, a health policy professor at the University of North Carolina-Chapel Hill. “Sen. McSally is trying to erase history for electoral purposes.”

Especially as COVID-19 cases climb, health care — and, in particular, the ACA — has emerged as a flashpoint in the Arizona election, said Dr. Daniel Derksen, a professor of public health, medicine and nursing at the University of Arizona.

“Martha McSally has in her actions, in her votes, been pretty consistent about cutting back benefits and trying to repeal the ACA without any clear plan in mind that would protect people who gained insurance through the ACA,” Derksen added. “Her words on preexisting condition protections don’t align with any votes I’ve seen.”

McSally’s campaign argued that the ACA is just one strategy, and a flawed one at that. Dylan Lefler, her campaign manager, instead pointed to her support of the Republican-backed Protect Act as evidence to back up her promise. Specifically, it ostensibly bans insurance plans from “impos[ing] any preexisting condition exclusion with respect to … coverage,” per the bill text.

The problem, though, is that simply banning that exclusion isn’t enough, because the law also has to make sure the health insurance plans that cover preexisting conditions remain affordable. The bill, sponsored by Sen. Thom Tillis (R-N.C.), does nothing to provide subsidies or cost-sharing mechanisms — meaning people both with and without preexisting conditions wouldn’t necessarily be able to afford those plans. Without that framework, the act remains a “meaningless promise,” argued Linda Blumberg, a fellow at the Urban Institute, a social policy think tank.

And it has other holes: for instance, permitting insurers to charge women more than men.

“No six-page bill is ever the way of achieving something,” said Thomas Miller, a scholar at the American Enterprise Institute. “This is a check-the-box effort to try to say, ‘We’re [moving] in that direction.’”

It’s not just legislation. There’s also Texas v. Azar, a pending case in which a group of Republican attorneys general are arguing the Supreme Court should strike the entire health law, including its preexisting condition protections. The Trump administration has sided with the Republican states.

McSally has consistently declined to comment on the lawsuit, saying she doesn’t want to weigh in on “a judicial proceeding.” In reporting this fact check, we asked where she stood on the case. The campaign didn’t specifically answer but pointed to her general disapproval of the ACA. Meanwhile, Senate Democrats have called on the administration to reverse its stance.

That context makes McSally’s silence especially relevant, said Sabrina Corlette, a research professor at Georgetown University.

“When given the opportunity, she has declined to oppose this lawsuit, which would essentially eliminate the protections that exist,” Corlette said.

So — big picture? McSally’s record in Washington hasn’t been one of preserving or building on preexisting condition protections.

Our Ruling

In her new TV ad, McSally claims she will “always protect those with preexisting conditions.”

But nothing in her voting record, which tracks closely with the Republican repeal-and-replace philosophy, supports this claim. And she has continually declined opportunities to oppose a pending legal threat to the ACA, including its provisions related to preexisting conditions, by a group of GOP governors and supported by the Trump administration.

Meanwhile, the legislation her campaign cited to justify her stance falls short in terms of meaningfully protecting Americans with preexisting medical conditions.

McSally has not in the past or present taken actions that back up her statement. We rate it False.
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Sweeps Of Homeless Camps Run Counter To COVID Guidance And Pile On Health Risks

DENVER — Melody Lewis lives like a nomad in the heart of downtown.

Poking her head out of her green tent on a recent June day, the 57-year-old pointed a few blocks away to the place where city crews picked up her tent from a sidewalk median earlier this spring and replaced it with landscaping rocks, fencing and signs warning trespassers to keep out.

Lewis then moved just a quarter-mile to a new cracked sidewalk, with new neighbors and potentially, homeless advocates fear, new sources of exposure to the coronavirus.

“Where else are we going to go?” Lewis asked. “What else are we going to do?”

Several cities across the U.S. are bucking recommendations from the Centers for Disease Control and Prevention by continuing sweeps of homeless encampments, risking further spread of the virus at a time when health officials seek to gain an upper hand on the pandemic.

Such struggles involving COVID-19 highlight the nation’s ongoing problem with housing. And they showcase the challenge public health officials face: Controlling the spread of the coronavirus also risks increasing the spread of other infectious diseases, such as hepatitis A, that thrive amid the trash-and-faeces strewn sidewalks that can be found in some encampments.

In Denver, Lewis and hundreds of others were displaced in late April and early May from sprawling, blocks-long encampments, as part of what city officials say is an ongoing effort to periodically clean city streets and keep infectious diseases down. Most homeless campers moved their belongings just a few blocks, where their tents now line more than a quarter-mile of sidewalks.

An hour south, in Colorado Springs, the police department said that it is continuing to follow CDC guidance to prevent COVID-19 among the city’s homeless population, but also that it has continued enforcing camping bans at certain times on public property, ticketing homeless people who are camping if they refuse to relocate. Those in the camps have said a bulldozer cleared at least one site.

And in St. Louis, the city’s health department ordered the removal of camps near City Hall, prompting an outcry from homeless advocates.

In all, at least a dozen cities in recent months have continued such camp removals — which goes against CDC guidelines amid the pandemic, according to the National Law Center on Homelessness and Poverty.

As some communities continue to reopen, and as downtown businesses welcome back employees and customers, some homeless advocates fear such sweeps will only worsen.

“There’s no strategy,” said Jacob Wessley, director of outreach and engagement for the Colorado Coalition for the Homeless. “That is our concern: When they do sweep this area, where are [those without homes] going to go?”

In Denver, one such cleanup in early May netted 9,500 pounds of trash and more than 50 hypodermic needles, according to Nancy Kuhn, spokesperson for the city’s transportation and infrastructure department.

“Denver has a responsibility to address unsafe, unhealthy, and unsanitary conditions impacting our community,” Kuhn said in an email.

Some cities said the pace of such sweeps has dropped dramatically during the pandemic.

Seattle officials conducted four such sweeps from mid-March to early June — each due to “extreme circumstances,” said Kevin Mundt, a spokesperson for Seattle’s human services department. That compares with 303 such camp removals in the final three months of 2019.

Honolulu created a dedicated area for people to camp and “quarantine” for about two weeks before moving into shelters, in case they had COVID-19. But some homeless campers who did not move had their camps dismantled, causing them to disperse through the community.

The goal was to limit the spread of the virus while encouraging campers to move indoors, said Marc Alexander, executive director of the city’s Office of Housing.

Even so, many homeless advocates say the CDC’s guidance is clear, and such efforts don’t pass muster. If individual housing units aren’t available, the CDC says, homeless campers should be allowed to remain in place during the pandemic. Tents should be at least 12 feet apart, and camps of more than 10 people should be provided hand-washing stations and hand sanitizer.

“Clearing encampments can cause people to disperse throughout the community and break connections with service providers,” the CDC guidance said. “This increases the potential for infectious disease spread.”

Already the disease has infected some people who lack permanent housing. In Colorado, for example, at least 483 homeless people have tested positive for COVID-19, state officials reported June 14. Nearly 80% lived in Denver.

Infection rates in the camps, however, are unclear. None of the 50 homeless campers in downtown Denver who agreed to coronavirus testing in early June was positive, according to the Colorado Coalition for the Homeless. But a different survey a month earlier indicated nearly a quarter of the 52 people tested at a nearby homeless service centre were infected with the virus, despite showing no symptoms.

David Scott loads supplies into his tent near 22nd Street in downtown Denver. He’s not worried about sweeps of homeless encampments because Denver officials told him he could return once the sidewalks are cleaned. “As long as they keep it to where we’re getting cleaned, not swept, it’s all right,” says Scott. (Jakob Rodgers for KHN)

Plastic fencing and landscaping boulders replace homeless campsites in downtown Denver. Advocates for the homeless fear that displacing encampments risks spreading the coronavirus throughout the homeless community. (Jakob Rodgers for KHN)

In downtown Denver encampments, dozens of tents stand packed together, often less than a foot apart along sidewalks. Hardly anyone wears masks, and many in the tent community said the virus is low on their list of concerns.

Several hand-washing stations accompany portable toilets in the area, each provided by a local advocacy group. But they don’t always have water.

For some homeless campers, the situation is preferable to staying in a shelter.

Avoiding those cramped confines and the accompanying risk of illness is “common sense,” said Erin Lorraine, 19, who has been homeless off and on for seven years. One sweep led her to move closer to the South Platte River on the west side of downtown.

“These are our homes,” Lorraine said. “We’re not hurting nobody.”

Not all homeless campers see Denver’s cleanups as so nefarious. Many said they were told by Denver officials that they could return after city crews sprayed down the sidewalk.

“As long as they keep it to where we’re getting cleaned, not swept, it’s all right,” said David Scott, 53.

But some of those displaced by previous sweeps say that trust has been broken.

Melody Lewis was away from her tent during a recent cleanup and returned to find that city crews had confiscated many of her belongings, including at least one tent, a bike and some shoes. She refused to go to a shelter, partly because of the threat of illness. As Lewis relates her story, an old sign hanging from a lamppost a few feet away is a reminder of a previous camp cleanup.

“We try to ignore it,” Lewis said of such warnings. “Our stuff and our minds are never secure.”

To limit the spread of the coronavirus, some nonprofits and cities — including some of the places conducting sweeps — have gotten creative, opening isolation shelters for people experiencing COVID symptoms and helping some particularly at-risk people move into paid motel rooms.

Recent sweeps also have renewed a conversation in Denver about whether to create sanctioned encampment sites — areas where people can pitch tents and live in socially distanced communities with a city’s blessing.

Elsewhere, such regulated camps lend homeless people stability, while increasing the odds that caseworkers can find their clients when housing becomes available, said Tom Luehrs, executive director of the St. Francis Center, a homeless services organization in Denver.

Already, San Francisco has temporarily created a few such encampments, with a total capacity of roughly 200 people.

“Some people have been out on the streets for years,” Luehrs said. “And that’s where they feel best about living because maybe we haven’t given them better options as a community.”

Colleen Echohawk, co-chair of Seattle’s Continuum of Care, a coalition of agencies and nonprofits working to address homelessness, said she empathizes with city officials who are having to juggle competing public health threats. Seattle is among the latest areas to face an outbreak of hepatitis A in its homeless community.

But Echohawk questions whether more could be done to limit the impact of sweeps.

“What’s frustrating about this is that you move them, and then they just moved into other encampments, and they took with them their COVID-19, and they took with them their hepatitis A,” Echohawk said. “It’s a real dilemma.”
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Officials Seek To Shift Resources Away From Policing To Address Black ‘Public Health Crisis’

From Boston to San Bernardino, California, communities across the U.S. are declaring racism a public health crisis.

Fueled by the COVID-19 pandemic’s disproportionate impact on communities of color, as well as the killing of George Floyd in the custody of Minneapolis police, cities and counties are calling for more funding for health care and other public services, sometimes at the expense of the police budget.

It’s unclear whether the public health crisis declarations, which are mostly symbolic, will result in more money for programs that address health disparities rooted in racism. But officials in a few communities that made the declaration last year say it helped them anticipate the COVID-19 pandemic. Some say the new perspective could expand the role of public health officials in local government, especially when it comes to reducing police brutality against Black and Latino residents.

“I’ve had a firm view [that] what hurts people or kills people is mine,” said Benjamin, a former state health officer in Maryland. “I may not have the authority to change it all by myself, but by being proactive, I can do something about that.”

While health officials have long recognized the impact of racial disparities on health, the surge of public support for the Black Lives Matter movement is spurring calls to move from talk to financial action.

In Boston, Mayor Martin J. Walsh declared racism a public health crisis on June 12 and a few days later submitted a budget that transferred 20% of the Boston Police Department’s overtime budget — $12 million — to services like public and mental health, housing, and homelessness programs. The budget must be approved by the City Council.

In California, the San Bernardino County board on Tuesday unanimously adopted a resolution declaring racism a public health crisis. The board was spurred by a community coalition that is pushing mental health and substance abuse treatment as alternatives to incarceration. The coalition wants to remove police from schools and reduce the use of a gang database they say is flawed and unfairly affects the Black community.

The city of Columbus and Franklin County, Ohio, made similar declarations in June and May, respectively, while Ingham County, Michigan, passed a resolution on June 9. All three mention the coronavirus pandemic’s disproportionate toll on minority residents.

Those localities follow in the footsteps of Milwaukee County, Wisconsin, which last year became the first jurisdiction in the country to declare racism a public health crisis, citing infant and maternal mortality rates among Blacks. The county’s focus on the issue primed officials to look for racial disparities in COVID-19, said Nicole Brookshire, executive director of the county’s Office on African American Affairs.

Milwaukee County was training employees in racial equity and had launched a long-term plan to reduce disparities in health when the pandemic hit. “It was right on our radar to know that having critical pieces of data would help shape what the story was,” said Brookshire.

She credits this focus for the county’s speedy publication of information showing that Black residents were becoming infected with and dying of COVID-19 at disproportionate rates.

Using data to tell the story of racial disparities “was ingrained” in staff, she said.

On March 27, the county launched an online dashboard containing race and ethnicity data for COVID-19 cases and began to reach out to minority communities with culturally relevant messaging about stay-at-home and social distancing measures. Los Angeles County and New York City did not publish their first racial disparity data until nearly two weeks later.

Declaring racism a public health crisis could motivate health officials to demand a seat at the table when municipalities make policing decisions and eventually lead to greater spending on services for minorities, some public health experts say.

The public is pressuring officials to acknowledge that racism shortens lives, said Natalia Linos, executive director of Harvard’s Center for Health and Human Rights. Police are 2½ times as likely to kill a Black man as a white man, and research has shown that such deaths have ripple effects on mental health in the wider Black community, she said.

“Police brutality is racism and it kills immediately,” Linos said. “But racism also kills quietly and insidiously in terms of the higher rates of infant mortality, maternal mortality, and higher rates of chronic diseases.”

The public health declarations, while symbolic, could help governments see policing in a new light, Linos said. If they treated police-involved killings the way they did COVID-19, health departments would get an automatic notification every time someone died in custody, she said. Currently, no official database tracks these deaths, although news outlets like The Washington Post and The Guardian do.

Reliable data would allow local governments to examine how many homeless or mentally ill people would be better served by social or public health workers than armed police, said Linos.

“Even symbolic declarations are important, especially if they’re accurately capturing public opinion,” said Linos, who is running to represent the 4th Congressional District of Massachusetts on a platform of health and equity. “They’re important for communities to feel like they’re being listened to, and they’re important as a way to begin conversations around budgeting and concrete steps.”

Derrell Slaughter, a district commissioner in Ingham County, Michigan, said he hopes his county’s declaration will lead to more funding for social and mental health as opposed to additional policing. Slaughter and his colleagues are attempting to create an advisory committee, with community participation, to make budget and policy recommendations to that end, he said.

Columbus City Council members coincidentally declared racism a public health crisis on May 25, the day Floyd died in Minneapolis. Four months earlier, the mayor had asked health commissioner, Dr. Mysheika Roberts, for recommendations to address health issues that stem from racism.

The recent protests against police brutality have made Roberts realize that public health officials need to take part in discussions about crowd control tactics like tear gas, pepper spray, and wooden bullets, she said. However, she has reservations about giving the appearance that her office sanctions their use.

“That definitely is one of the cons,” she said, “but I think it’s better than not being there at all.”

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Drinking Surged During The Pandemic. Do You Know The Signs Of Addiction?

Despite the lack of dine-in customers for nearly 2½ long months during the coronavirus shutdown, Darrell Loo of Waldo Thai stayed busy.

Loo is the bar manager for the popular restaurant in Kansas City, Missouri, and he credits increased drinking and looser liquor laws during the pandemic for his brisk business. Alcohol also seemed to help his customers deal with all the uncertainty and fear.

“Drinking definitely was a way of coping with it,” said Loo. “People did drink a lot more when it happened. I, myself, did drink a lot more.”

Many state laws seemed to be waived overnight as stay-at-home orders were put into place, and drinkers embraced trends such as liquor delivery, virtual happy hours and online wine tasting. Curbside cocktails in 12- and 16-ounce bottles particularly helped Waldo Thai make up for its lost revenue from dine-in customers.

Retail alcohol sales jumped by 55% nationally during the third week of March, when many stay-at-home orders were put in place, according to Nielsen data, and online sales skyrocketed.

Many of these trends remained for weeks. Nielsen also notes that the selling of to-go alcohol has helped sustain businesses.

But the consumption of all this alcohol can be problematic for individuals, even those who haven’t had trouble with drinking in the past.

Dr. Sarah Johnson, medical director of Landmark Recovery, an addiction treatment program based in Louisville, Kentucky, with locations in the Midwest said that virtual events aside, the pandemic has nearly put an end to social drinking.

“It’s not as much going out and incorporating alcohol into a dinner or time spent with family or friends,” Johnson said. “Lots of people are sitting home drinking alone now and, historically, that’s been viewed as more of high-risk drinking behavior.”

There are some objective measures of problematic drinking. The Centers for Disease Control and Prevention defines heavy drinking as 15 or more drinks a week for a man or eight or more for a woman.

But Johnson said that more important clues come from changes in behavior. She explains that, for some people, a bit of extra drinking now and then isn’t a big deal.

“If they are still meeting all of their life obligations like they are still getting up and making their Zoom meetings on time, and they’re not feeling so bad from drinking that they can’t do things, and taking care of their children and not having life problems, then it’s not a problem,” Johnson said. “It’s when people start to have problems in other areas of their life, then it would be a signal that they are drinking too much and that it’s a problem.”

But there are signs to watch out for, she says. They include:

  • Big increases in the amount of alcohol consumed
  • Concern expressed by family or friends
  • Changes in sleep patterns, either more or less sleep than usual
  • Any time that drinking interferes with everyday life

Johnson noted that for many people, living under stay-at-home orders without the demands of a daily commute or lunch break could be problematic.

Darrell Loo, the bar manager for Waldo Thai in Kansas City, Missouri, says curbside cocktail sales helped his restaurant get through the pandemic shutdown.(Alex Smith/KCUR)

“Routine and structure are important to overall mental health because they reduce stress and elements of unknown or unexpected events in daily life,” Johnson said. “These can trigger individuals in recovery to revert to unhealthy coping skills, such as drinking.”

Johnson explained that while some people may be predisposed to problematic drinking or alcohol-use disorder, these can also result from someone’s environment.

Johnson said that people who are unable to stop problematic drinking on their own should seek help. The federal Substance Abuse and Mental Health Services Administration runs a 24/7 helpline (800-662-HELP) and website, www.findtreatment.gov, offering referrals for addiction treatment.

Peer support is also available online. Many Alcoholics Anonymous groups have started to offer virtual meetings, as does the secular recovery group LifeRing. And for people who are looking for more informal peer support, apps such as Loosid help connect communities of sober people.

Darrell Loo at Waldo Thai said that he has been concerned at times about people’s drinking but that he generally has seen customers back off from the heavy drinking they were doing early in the pandemic.

Loo and others in the Kansas City restaurant business are pushing for the carryout cocktails and other looser laws to stay in place even as restaurants slowly start to reopen.

“This will go on for a while. It’s going to change people’s habit,” Loo said. “People’s spending habits. People’s dining out the habit. So there’s definitely a need to keep doing it.”

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California Lawmakers Block Health Care Cuts

SACRAMENTO — Gov. Gavin Newsom and Democratic state lawmakers agreed Monday on a state budget plan that would avoid the deep cuts to essential health care services that the governor had initially proposed.

Even though the state faces a massive budget deficit, legislators flatly rejected Newsom’s proposed cuts to safety-net programs intended help keep older adults and low-income residents out of long-term care homes, the epicenters of coronavirus outbreaks.

“The demand for these services is even more imperative, even more needed,” said Sen. Richard Pan (D-Sacramento), who chairs the Senate Health Committee. “The more people keep out of nursing homes, the better.”

To address the estimated $54 billion deficit in the 2020-21 state budget, the deal relies partly on drawing down state cash reserves and rainy day funds. But it still includes cuts, such as reductions to state employee pay and deferred payments to K-12 public schools. It also counts on future federal COVID-19 relief aid from Congress.

Lawmakers, still finalizing details, are expected to vote on the proposal later this week. Newsom must sign it by July 1, when the spending plan would take effect.

Newsom negotiated the plan with legislative leaders, including Assembly Speaker Anthony Rendon and Senate President Pro Tem Toni Atkins. In a joint statement, they described an unprecedented pandemic that has forced them to “make hard choices and figure out how to sustain critical services with much less.”

“In the face of these challenges, we have agreed on a budget that is balanced, responsible and protects core services — education, health care, social safety net and emergency preparedness and response,” they said.

In May, Newsom proposed $14 billion in cuts, including the elimination of several Medi-Cal services, along with sweeping cuts to other safety-net programs and education. He had described the cuts as painful, but necessary to balance a state budget decimated by the novel coronavirus. For instance, the state has been hit by plummeting tax revenues and additional costs related to pandemic response, such as paying a record number of unemployment claims. California’s unemployment rate was 16.3% in May.

However, lawmakers balked at cutting Medi-Cal programs amid the pandemic, which has hit older people and those with chronic health conditions the hardest. About one-third of Californians are enrolled in Medi-Cal, the state’s Medicaid program for low-income people.

“We’re relieved that many of the worst of the cuts were prevented. We’re going to need to fight for federal funds and state funds in the future,” said Anthony Wright, executive director of the advocacy group Health Access California.

Among the Medi-Cal programs that will remain funded in the final budget are ones that aim to keep older Californians out of nursing homes: the Multipurpose Senior Services Program, which links social workers to seniors still living in their homes, and Community-Based Adult Services, which provides recreation and medical care to seniors and people with disabilities.

Californians who rely on caregivers paid by the state to help them live at home no longer have to worry about a 7% cut Newsom had proposed for In-Home Supportive Services. And the budget preserves funding for “optional” Medi-Cal benefits, such as adult podiatry care, eyeglasses, speech therapy and hearing exams — benefits that lawmakers had just recently restored after they were cut in the last recession.

“A lot of these benefits are benefits provided in the private market,” said Linda Nguy, a policy advocate at the Western Center on Law & Poverty. “Having a lower standard for public programs for low income and communities of color is problematic, especially in a public health crisis.”

Lawmakers also rejected Newsom’s plan to redirect $1.2 billion from Proposition 56 funds to help pay for a projected surge in Medi-Cal enrollment. That money, raised by a tobacco tax, now helps pay physicians, dentists and other health care providers who treat Medi-Cal patients.

Pan said it is important those payments continue, as mandated by Proposition 56. “I appreciate the governor respected the will of the voters,” he added.

The Newsom administration estimated that counties will lose $1.7 billion in public health funding between January 2020 and the end of June 2021 because of lower sales tax revenues and vehicle license fees. To help them make up for that loss, the budget includes $750 million in state money, and counties would get an additional $250 million if the federal government approves new COVID-19 relief money for states.

That’s far less than what counties throughout California say they need for COVID-19 response and other public health programs.

Not all state health care programs escaped budget cuts.

The expansive health care agenda outlined at the beginning of the year by both the governor and the legislature is on hold, including an effort to expand Medi-Cal coverage to undocumented immigrants 65 and older; a new initiative to shelter homeless people, called “CalAIM”; and a revamp of the mental health care system.

“We made compromises across the spectrum,” Newsom told reporters Monday. “This is a multiyear framework. We’re not solving for everything. We have a lot of work to do for the next few years.”

The budget deal did not include $4 billion requested by the California Hospital Association, which has said hospitals statewide have lost about $15 billion because the pandemic has forced them to buy masks and other protective equipment, cancel elective surgeries and free up hospital beds.

California hospitals have received about $3 billion in federal funds, said Carmela Coyle, president of the association. However, it is not nearly enough to offset the huge revenue losses that have triggered furloughs and layoffs she said.

“Without financial relief from the state, hospitals may have to continue workforce reductions, pay cuts and more,” Coyle said in a statement. “This is a time when hospitals urgently need state support so they can remain open, staffed and ready.”

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Easy To Say ‘Get Tested.’ Harder To Do. Here’s How.

Will Bondurant decided to get tested for COVID-19 after attending three racial justice demonstrations over a five-day period in San Francisco, where he lives.

The first, on June 3, “was the scariest and most risky from the point of view of COVID infection,” said Bondurant, 31. Although most wore masks, participants were jammed in, unable at times to maintain the recommended 6-foot distance, he said.

Bondurant did not have any COVID symptoms but went for the test because he had a meeting scheduled the following weekend with a friend in his late 70s.

As protests continue to ripple across the country nearly a month after Minneapolis resident George Floyd died under a policeman’s knee, political leaders and public health experts warn that mass gatherings — including the indoor Tulsa, Oklahoma, campaign rally President Donald Trump held Saturday — will further fuel new coronavirus cases.

Robert Redfield, director of the Centers for Disease Control and Prevention, told members of Congress earlier this month that those who have participated in the protests should “highly consider” getting a diagnostic test for COVID-19. New York Gov. Andrew Cuomo said it was their “civic duty” to do so.

The challenge is to get tested in a way that will yield useful information.

If you have symptoms of COVID-19, such as a fever, cough, sore throat or difficulty breathing, you should seek testing immediately, health care professionals say. If you have no symptoms, here are guideposts for testing:

Timing

Experts disagree on how long to wait post-exposure before being tested: Some say at least three or four days, others say at least seven. The longer you wait, the greater the chance a test will detect any virus. But you need to weigh that against the risk of exposing others if you are infected.

Keep in mind that a test is relevant only for the day you take it. If you plan to attend more protests, you may need to be tested again — and again. And if you’re tested too early in the course of infection, the test might not detect it.

That could give false reassurance since the virus can take up to 14 days to incubate, said Dr. Ravi Kavasery, a medical director at AltaMed Health Services, a large chain of community clinics in California.

Bradley Pollock, associate dean for public health sciences at the UC Davis School of Medicine, belongs to a group of University of California health experts that had initially recommended protesters get a test three to seven days after a protest, but he now suggests waiting at least seven days.

It can take up to three days to receive test results.

How Great Was Your Risk?

“Any large gathering creates risk for transmission,” said Anne Rimoin, a professor of epidemiology at UCLA’s Fielding School of Public Health. “It’s just common sense that when you have events where people are shouting or singing or chanting and in close proximity to each other, that is the perfect storm.”

Indoor gatherings are generally considered far riskier than outdoor ones. To assess the seriousness of your exposure risk, Dr. William Miller, a professor of epidemiology at Ohio State University, suggests you consider:

  • Was it difficult to maintain social distancing?
  • Were people near you not wearing a mask, or coughing, shouting, or singing? Many people, or just one?
  • Do you live in an area with a large number of new COVID-19 cases every day, or where the daily number is increasing?

“If your answers to those questions are yes, the risk is greater — and so is the benefit of being tested,” Miller said.

Public health experts say the risk is even higher if you were in a crowd where police sprayed tear gas, which makes people cough and rub their eyes — both potentially perilous in the era of COVID-19.

Greater Test Availability

If you decide to get tested, the availability of test sites varies widely by region. Most community health centers now offer testing, as do large urgent care centers and a growing number of CVS and Walgreens pharmacies. Google will show a list of testing sites in your area if you type in “COVID tests near me.” Remember that you want a COVID virus test — not an antibody test, which is designed to detect past infection.

Some sites may require a prescription for the test, or restrict testing to people with symptoms and workers deemed essential. In some jurisdictions, including California’s Los Angeles, Riverside and Santa Clara counties, testing is available free to all residents, symptomatic or not.

Several U.S. cities, including Boston, San Francisco, Atlanta, Seattle and Louisville, Kentucky, have offered free COVID-19 tests to people who say they participated in the protests.

Federal law requires all insurers to cover the entire cost of testing for the virus, regardless of symptoms and when or where a possible infection may have been acquired. However, some health plans require that the test be ordered by a doctor.

There is also the option of using one of several FDA-authorized home tests, including ones from LabCorp, EverlyWell Inc. and Phosphorus Diagnostics. They cost from $75 to $150, and results are typically posted online within three days.

Medicare covers their cost, as do private insurers, although, again, the private health plans may require a referral from a health provider.

People who are uninsured can get cost-free COVID testing through Medicaid in 21 states, and a separate federal program reimburses medical providers for the cost of testing the uninsured.

Accuracy Has Improved

FDA-validated home tests have accuracy percentage rates “in the high 90s,” said Mark Cameron, an immunologist and an associate professor at the Case Western Reserve University School of Medicine in Cleveland. But since the tests are new and were approved on an emergency basis, take any result with a grain of salt, he suggested.

The “nasopharyngeal” test, in which a medical professional slides a long swab to the back of your nasal cavity, is considered by many public health experts to be the gold standard. Less invasive options include oral swabs, shallower nasal swabs and, more recently, a saliva test.

“Oral swabs are probably not as good as nasopharyngeal swabs, but they may be good enough,” said Pollock.

Several factors can cause a test to inaccurately miss an infection, including human error in collecting the sample and a low viral load in the swabbed area.

The most important factor might be the timing of the test.

Bondurant, the San Francisco resident, struggled with that calculation, because he needed the result before he visited his elder friend.

He decided to take the test on June 9, six days after the first protest he attended. The result came back the very next day — negative, he said.

But UCLA’s Rimoin counsels caution on interpreting a test that shows no infection. “A negative test a week after being exposed certainly reduces the likelihood that somebody is infected, but it certainly does not eliminate that possibility completely,” she said.

That’s why many public health experts recommend that, regardless of testing, you limit interactions with others for 14 days after potential exposure to the virus.

“Any opportunity for spread in uninfected populations, this virus will take it,” Rimoin said. “The thing people need to remember is that we may be really tired of this virus, but this virus is nowhere near tired of us.”

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Same old, same old, with NY Times Well column – bisphosphonates for pneumonia this time

While the overarching theme may be the same – the puzzling editorial decision-making in the New York Times Well blog/column – the specific topics change – and so, provide more examples for instruction.

Bone Drugs May Have Added Benefit: Lower Pneumonia Risk is the headline of the latest troubling piece that caught my eye. The opening line:

Osteoporosis drugs such as Fosamax and Actonel may have an additional benefit: A new study suggests they are associated with a reduced risk for pneumonia.

The entire story used 220 words.  There is very little that can be covered effectively in a news story about a biomedical research study in so few words. The story did manage to confuse quite effectively.

Even that opening line mixes the fact that the study only showed a statistical association with the assertion that it showed cause-and-effect.  When it pointed to a possible “additional benefit” from the use of osteoporosis drugs – or bisphosphanates – it crossed a line.

At the end, it included a quote from one of the study co-authors and paraphrased him stressing “that the study is observational and does not prove cause and effect.”

But the story used cause-and-effect language throughout:

  • additional benefit
  • reduced risk for pneumonia
  • The reason for the effect is unclear
  • bisphosphonates lowered the risk

If the study did not prove cause-and-effect, which it did not, then you can’t prove benefit, risk reduction or lowering, or an effect.

This is a common failure in the Times’ Well blog/column. We regularly point to our primer to help journalists do a better job on observational studies, Observational studies: Does the language fit the evidence? Association vs. causation.

Worse, though, in this case, is that in the entire story there was only discussion of benefits from bisphosphanates and not one mention of side effects or potential harms. We have regularly warned readers that if you ever read a story about a drug study that only discussed potential benefits – but not harms – you should run for the hills because there’s no such thing.

And the potential side effects and harms of bisphosphanates are well known.

  • Therapeutics Initiative: Given that bisphosphonates can cause severe adverse effects including fractures, which they are meant to prevent, it is urgent that the overall benefits and harms of long-term treatment be clarified. The available evidence suggests that the benefit-harm balance may be unfavourable for their use in osteoporosis.
  • Ten years ago The Food and Drug Administration (FDA) warned that there is a possible risk of a rare type of thigh bone (femoral) fracture in people who take drugs known as bisphosphonates to treat osteoporosis.
  • Nine years ago the Center for Medical Consumers published “Warning on bone drugs: stop after 5 years.”
  • Five years ago The BMJ, under its Too Much Medicine heading, published, “Overdiagnosis of bone fragility in the quest to prevent hip fracture.” That paper concluded: “(Drug therapy) can achieve at best a marginal reduction in hip fractures at the cost of unnecessary psychological harms, serious medical adverse events, and forgone opportunities to have greater impacts on the health of older people. As such, it is an intellectual fallacy we will live to regret.” The paper stated that “Bisphosphonates are the dominant drugs for fracture prevention.”

This is just a snapshot of the voluminous and evolving medical literature on the harms of bisphosphanates.

But the New York Times never acknowledged that any harms exist – only benefits – and now unproven “additional benefits.”

As I always do, I checked the reader comments in response to this piece. The Times should learn from the experience of its readers.  Comment excerpts:

  • “Fosomax and those drugs are notorious for bad side effects, involving jaw death among other things. My dentist told me to stay as far away from them as possible. There’s no way I would take that stuff just to “maybe” reduce my risk of pneumonia. There’s a pneumonia vaccine that’s probably a world safer than a biphosphonate if you want to prevent pneumonia. And far better drugs if you want to fight bone loss.”
  • “I had a femur fracture as a result of taking bisphosphonates—Fosomax, Actonel and Boniva. I know doctors do not like to hear this… those meds can be dangerous and should have black box warnings. Doctors will tell you there are “rare fractures” but the numbers of femur fractures are inaccurately counted. And now you make an observational claim that they help with pneumonia.”
  • “Are people really still taking Fosomax? It’s a nasty drug that put my mother into the hospital for 10 days with a gastrointestinal track inflamed from beginning to end. People have suffered from other side effects including fractures. I thought they had cut way back on prescribing this medication.”

Finally, with all the resources of the Times, the story only quoted one source – a co-author of the paper.  No independent perspective was included.

Why was this newsworthy – when the world is focused on the COVID-19 pandemic?  Why was this worth even 220 words now?  Why did the story explain that the study didn’t prove cause and effect, but then used cause and effect language six times (including the headline)? Why no mention of harms?  Why was there no independent perspective with no conflict of interest?

These are the kinds of questions that should be answered for readers.  The Times, which is delivering some stellar journalism on COVID-19, should abandon 220-word stories like this one.  It only adds to the cacophony of noise from not-ready-for-prime-time health care news.
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Injured And Uninsured, Protesters Get Medical Aid From LA Doctor

It wasn’t Deon Jones’ fractured cheekbone or even his concussion that most worried Dr. Amir Moarefi. He was most concerned that Jones could go blind.

“He sustained a rubber bullet direct injury to the cheek, which broke his zygomatic bone, which is your cheekbone, literally about an inch and a half from his eye and about another inch and a half from his temple,” Moarefi said.

The death of George Floyd led to a national wave of protests against police brutality and racism. Law enforcement’s attempts to control impassioned, mostly peaceful crowds have included tactics often deemed “less than lethal,” such as tear gas, pepper spray, and rubber bullets. But depending on where a person is hit, Moarefi said, those tactics can cause serious long-term injuries. And, they can kill people.

Jones was hit with a rubber bullet during a protest at Pan Pacific Park in Los Angeles on May 30. He managed to get to the emergency room at Cedars-Sinai with the help of a health care worker who was also protesting. The X-rays confirmed he had facial fractures and doctors recommended he follow up with an ophthalmologist to make sure his optic nerve hadn’t been damaged by the impact.

“I had bruising under my eye and it was puffy as well, and I don’t currently have health insurance,” Jones said.

He wasn’t sure how he’d get the care he needed from a specialist until a friend told him about a local doctor who offered to treat injured protesters, especially those without health insurance.

A photo of a protester who developed a severe rash after exposure to tear gas. The injured protester contacted Dr. Amir Moarefi for help after seeing Moarefi’s offer for free medical assistance posted on Instagram.(Jackie Fortiér/LAist)

“I called him, then went in and I filled out some paperwork,” Jones said. “I remember the girl saying, ‘Your visit today will be free,’ and I thought about how many people need to hear that.”

In a June 4 statement, the American Academy of Ophthalmology called on domestic law enforcement officials “… to immediately end the use of rubber bullets to control or disperse crowds of protesters.”

Instagram Medicine

Jones is one of the hundreds of people who have contacted Moarefi for medical help since the Long Beach, California, an ophthalmologist posted his offer on Instagram.

“I started to get the messages coming in and first it started off with a lot of virtual consults, a lot of messages, pictures, FaceTime chats,” Moarefi said.

The requests for help quickly snowballed. His Instagram post was shared among protest groups all over the country.

“I’ve seen broken ankles, broken hands, broken fingers, welts all over the body. I’ve seen people who have sustained really bad tear gas injuries, where their entire face broke out into these nasty hives, including their eyes. Pepper spray, I’ve seen really bad cases. You could just see visible swelling of their eyeball,” Moarefi said.

In between regularly scheduled surgeries, Moarefi checks his phone for new requests. To treat protesters in other states, he has formed a loose network of doctors he knows from medical schools and conferences. Mostly he gives people medical advice via text.

Even though clashes with the police have largely died down, some protesters have festering wounds from days-old injuries.

“You get that adrenalin where you feel like you’re OK. But then later when you go home, you may be doing more harm than good [by not having an injury evaluated immediately],” Moarefi said.

After he offered assistance via Instagram, Dr. Amir Moarefi received thousands of messages and pictures like this one from injured protesters asking for help. He mostly gives medical advice via text.(Jackie Fortiér/LAist)

Health Care As A Form Of Protest

Treating protesters is the ophthalmologist’s mode of protest against racial injustice and a health care system that he said doesn’t treat people of color equitably.

“The feeling of injustice is what this is all about. And this is just more little bits of injustice that people are feeling if they’re peacefully protesting, and they’re getting hurt,” Moarefi said.

The large number of reported injuries during the protests, including among KPCC/LAist reporters, has led to demands for law enforcement to stop using less-than-lethal weapons at mass gatherings.

A coalition of community activists and civil rights lawyers called on the L.A. Police Commission to ban their use against protesters. A spokesperson for LAPD declined to comment on the demands.

In a statement, the LAPD said the department is looking into allegations of misconduct and use of excessive force against protesters. The department said it has assigned 40 investigators to the task and reported a total of 56 complaint investigations, 28 of which involve alleged uses of force.

If the demonstrations continue, Moarefi and a group of 11 doctors, nurses, and EMTs plan to take medical kits and treat people right on the street.

“When I put my head down and I got my pillow at night, I want to know that I’ve done everything that I can to help support a cause that I believe in,” he said.

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‘Just Make It Home’: The Unwritten Rules Blacks Learn To Navigate Racism in America

ST. LOUIS — Speak in short sentences. Be clear. Direct but not rude. Stay calm, even if you’re shaking inside. Never put your hands in your pockets. Make sure people can always see your hands. Try not to hunch your shoulders. Listen to their directions.

Darnell Hill, a pastor and a mental health caseworker, offers black teenagers these emotional and physical coping strategies every time a black person is fatally shot by a police officer. That’s when parents’ worries about their sons and daughters intensify.

“They’re hurting,” Hill said. “They’re looking for answers.”

Hill, who is African American, learned “the rules” the hard way. When he was 12, he and a group of his friends jumped a fence to go for a swim in a lake. That’s when two officers approached them. One of the cops, a white man, threatened to shoot Hill and everyone else if he ever caught them there again.

“I was so afraid,” Hill, now 37, recalled. “He made all of us sit down in a line right by the lake.”

He still tells himself that the officer didn’t mean what he said that day. But Hill’s tone changes when he thinks about the second time white men threatened him with a gun.

Hill and his family moved to a small, mostly white town in Florida. He rarely left the house at night, but one day when he was a sophomore in high school, his grandmother, who wasn’t feeling well, asked him to take their car and drive to a convenience store for ginger ale.

He got lost along the way and asked two white men for directions. Instead of offering help, the men tormented him, Hill said. When he tried to drive away, the men followed him in their vehicle, chasing him around in the dark. He thought surely they would kill him if they caught him.

“They told me it was [N-word] season,” Hill recalled. “I was terrified.”

The traumatic event is hard to talk about, Hill said. His voice still shakes as he describes how the night unfolded. That’s one reason he’s helping teenagers unpack their trauma — and guard against experiencing more — as they try to cope with the mental health burden of other people’s racist assumptions.

His unofficial guide to what he calls “living while black” can be tough to remember under pressure. But Hill said the survival skills feel essential to many who grow up feeling that the color of their skin makes them vulnerable to becoming the next George Floyd, an unarmed black man killed by a white Minneapolis police officer on May 25, an event that has prompted civil rights protests around the world.

But well before Floyd’s death, Hill’s phone began to ring more. It was the start of the coronavirus pandemic and his young clients from the Hopewell Center, a mental health agency in St. Louis, needed help processing the closing of schools, loss of jobs, social isolation and loss of loved ones. So instead of working from home, Hill put a folding chair in the back of his car and started making house calls. He planted his seat in front yards and sidewalks while his clients stayed on their front porches.

The conversations Hill was having grew more complicated, though, after Floyd’s killing. Two months before Floyd’s death, Breonna Taylor was killed in Kentucky after officers with the Louisville Metro Police Department entered the black woman’s apartment dressed in plainclothes. Taylor’s boyfriend thought the officers were intruders, so he fired a single shot. Officers responded by shooting Taylor at least eight times. Ahmaud Arbery, a 25-year-old black man, was chased down and fatally shot while jogging in Glynn County, Georgia. Three white men were arrested.

The mental anguish for some black families exploded as they saw these images and stories repeatedly on the news.

“When these happen, we have to address them,” said Lekesha Davis, vice president of the Hopewell Center. “It’s having a direct impact on [black families’] mental and emotional well-being.”

Hill offers coping skills as he makes his rounds every week. His conversations during regular visits now include discussions about police brutality, civil unrest and how to survive. Part of Hill’s work is teaching the mechanics of navigating everyday encounters — from walking in a public space like a park to being stopped by the police or entering a business.

Isaiah McGee, 18, is a mentee of Darnell Hill’s. McGee has aged out of the program at the Hopewell Center where Hill works as a mental health caseworker, but Hill still checks in with McGee every other week. (Courtesy of Isaiah McGee)

Don’t make any sudden moves. Watch your body language. Don’t point your fingers, even if you’re mad. Don’t clap your hands. Listen. Know the law. But don’t say too much. Make eye contact.

While many black families have their own sets of rules, he hopes that following his “do’s and don’ts” will allow kids to survive as unscathed as possible to realize their life ambitions. “Let’s just make it home,” Hill tells them. “We can deal with what’s fair or not fair, what’s racial or not racial at a later date.”

White children and teenagers, meanwhile, aren’t generally taught these sometimes futile survival skills with the same urgency. They’re just as unlikely to learn about the systemic racism that continues to create the problems, and almost certainly not what it would take to undo it.

Hill knows his training sessions don’t guarantee a win. He’s a husband, father, nonprofit board member and the president of the parent-teacher organization at his youngest child’s school. His voice is friendly and his demeanor is calm. Still, sometimes none of that matters when Hill drives in a predominantly white neighborhood. While he knows not all white people stereotype him, he remains aware that his height and weight (he’s 5-foot-10 and over 300 pounds) and the color of his skin could turn him into a target — even when he’s trying to order lunch.

It’s impossible for him to prevent an officer from invading the wrong apartment. He can’t teach black boys how to sleep, jog or bird-watch in non-threatening ways. And he can’t stop a prejudiced cop from firing shots at an unarmed black man.

Hill’s just glad he can fill in the gaps when families need him. And he knows it has helped on occasion: A 16-year-old client recently told him he’d channeled his advice when he was stopped by two police officers near Ferguson, Missouri. The teenager had been walking around with his lawn mower to make some money cutting grass. On his way home, the officers stopped him and asked why he was outside and how he had obtained the lawn mower. The teen told Hill the next day his advice had helped him stay calm and defuse the situation so he could get home safely.

Another teen Hill has worked with, Isaiah McGee, 18, has aged out of Hopewell’s youth mental health program, but Hill still checks in with him every other week.

The teen recently graduated from high school and plans to study music in college this fall. “I’m just trying to make it somewhere in life,” McGee said. “Leave my thumbprint on the world, become a legend.”
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