Hospitals would have to hire more nurses to meet staff-to-patient ratios and avoid excessive overtime under a package of bills, known as the Safe Patient Care Act, introduced this in late February in the House and Senate.

The bills would set nurse-staffing levels according to what kind of care they provide. In the intensive care unit (ICU), the ratio would be one-to-one. On a medical-surgical floor, the ratio would be four patients per registered nurse. In post-partum, where baby and mother are fine, the level would be six-to-one, explained sponsor Rep. Jon Hoadley (D-Kalamazoo).

“We think this will encourage hospitals to do what they should be doing, which is to have enough nurses on staff and to be properly prepared for every situation,” said Dawn Kettinger of the Michigan Nurses Association. “A lot of nurses are leaving the profession because of unreasonable workload and unreasonable hours, putting them and their patients in jeopardy.

Until we make a real commitment to proper staffing and keep it at the levels that it should be, we are going to continue to lose nurses out of the profession. It is not just a matter of producing more nurses. It is also a matter of keeping them in the profession.”

Hospital human resources departments would love to hire more nurses, says Laura Wotruba of the Michigan Health and Hospital Association, but there is not enough supply to meet the demand.

And they are already making efforts to avoid mandatory overtime for nurses, including recruiting volunteers for overtime, adding on-call incentives, offering extra hours and shifts to part-time and per diem workers, using staffing pools and agencies, Wotruba said. Sometimes, they have to divert ambulances to other hospitals when they are short-staffed and “limit their patient census.”

When California instituted similar nurse-to-patient ratios, she said, it made the wait times in emergency departments go up, not down.

“People had to wait longer to get the care they needed in an emergency department setting,” Wotruba explained. “What happens, if you have a really busy day in your emergency department, you might have to scramble to make sure you are not exceeding that ratio. So you don’t want to bring people back if you don’t have enough nurses to go around to see all the patients that you’ve got waiting.”

Hospitals operate 24 hours a day, 365 days a year, so they need the flexibility to staff appropriately for their particular circumstances, Wotruba contended.

The package includes three bills in the Senate, three in the House. Hoadley’s bill, HB 4279, and SB 0159, by Sen. Ed McBroom (R-Vulcan), would set those ratios and require hospitals to have a staffing plan.

HB 4280, by Rep. Sara Cabensy (D-Marquette), and SB 0160, by Sen. Stephanie Chang (D-Detroit), would prohibit excessive mandatory overtime and require at least eight hours off after a 12-hour shift.

HB 4281, by Rep. Aaron Miller (R-Sturgis), and SB 0161, Sen. Jeremy Moss (D-Southfield), would require hospitals to release their actual nurse-to-patient ratios “so consumers can make informed choices.”

The package is a reintroduction of a package introduced last session, also called the Safe Patient Care Act.

The package got a hearing, but never got out of committee. The issue has been around for a long time. Some legislation regarding nurse-staffing levels has been introduced in every session since 2004.

But Kettinger notes that this year Miller’s HB 4281 has 57 co-sponsors, suggesting that if were put on the board it would pass. Many of those lawmakers co-sponsored other pieces of the package, but the other bills do not have a majority yet.

Wotruba said the Legislature has many new members, so MHA’s job will be to share information and educate the members on the possible impact of such a package.

Cost is a factor. She noted that Massachusetts had a question on the ballot this past fall to expand its nurse-to-patient ratios, which now apply only to the ICU at two-to-one. The question failed, but the cost of the expansion, by some studies, would have come to nearly $1 billion.

“That’s not chump change,” she said.

Kettinger contended there are places in health care to cut costs, including CEO pay and administrative costs.

“It is a scare tactic to say we are going to have an increase in health care costs because we are getting what we are supposed to get, that we are paying for already. Right now, we are paying a lot for health care and we’re being denied nursing care that we are already paying for in many cases. I think there is a question of value in addition to costs,” Kettinger said.

Hoadley also is not convinced it would increase costs, arguing it might save money in the end by avoiding re-hospitalizations and reducing accidents.

“When we talk about the types of spending that actually saves money in the long run, appropriate staffing care is right up there. It changes one part of the balance sheet, but improves reimbursements on the other,” Hoadley said. “I think we all know that, particularly around hospital billing, there seems to be often times a disconnect between the direct services provided and what ends up on your bill.”

He contended that asking nurses to repeatedly work excessive overtime and cover long shifts has a psychological impact and makes for stressful working conditions.

“You can be so tired it is essentially like you are working drunk. That is why we have reasonable limits on truck drivers and pilots and other professionals. That is part of the conditions. We’re just trying to make sure we are putting the patient care first at the end of all this,” he said.

Cambensy said her mother was a nurse.

“Growing up, I felt the impact in my own family as I watched my mother have to take on unexpected shifts and long hours. No one can expect nurses to keep patients safe and well-cared for when they themselves are exhausted or sleep-deprived,” Cambensy said.

Miller said that if hospitals are staffing at proper nursing levels, they should have no problem sharing that information.

“It’s just plain wrong that people can’t get important information about the nursing care at their local hospital. This legislation ensures we all have the facts about how many patients our nurses are being assigned, which directly affects the quality of our care,” Miller said.

Wotruba suggested that if you are going into a hospital and you have concerns about nurse staffing, you can just ask your healthcare provider about it.

Former State Employee Charged In $200K Medicaid Kickback Scheme

A former state employee is being charged with three felonies for allegedly giving herself $200,000 as part of a Medicaid kickback scheme, according to an announcement made Feb. 28 by Attorney General Dana Nessel and Department of Health and Human Services Director Robert Gordon.

Eliza Yulonda Ijames, 56, a former DHHS employee, has been charged with three felonies, including one count of Medicaid Fraud-Conspiracy and two counts of Medicaid Fraud-Kickbacks.

She is alleged to have referred clients to agencies with which she had a personal and financial relationship and approved payments to those same agencies, according to a press release. Representatives from these agencies then deposited funds into bank accounts owned in part by Ijames, and she allegedly withdrew nearly $200,000 from these accounts for her personal use between about January 2015 and December 2017.

Medicaid Fraud-Conspiracy is a 10-year, $50,000 penalty. Medicaid Fraud-Kickbacks is a four-year, $50,000 penalty.

The matter was referred to the AG’s Office by the DHHS Office of Inspector General after an investigation. Ijames worked as an Independent Living Services Specialist within the Wayne County Adult Services office.

Ijames was arraigned Feb. 28 before Judge Richard BALL of the 54B District Court in East Lansing and given a $10,000 personal recognizance bond. She is next due in court for a preliminary exam on March 8.

Mental Health Funding Source Moves Out Of Panel

Four percent of the state’s liquor tax money—roughly $18 million—would go every year to substance abuse programs under legislation that moved out of a House committee Feb. 28.

HB 4057, a version of a Rep. Steve Marino (R-Harrison Twp.) bill from last year, creates a revenue stream for community mental agencies as they try to treat alcohol and drug addictions.

The Michigan Association of Counties, the Community Mental Health Association of Michigan and other treatment organizations are supporting the legislation, an offshoot of last term’s House CARES Task Force on mental health treatments.

Of the new revenue stream HB 4057 would create, 25 percent would go specifically to treat something other than alcohol addiction—opioids, for example, which Marino called an epidemic in his home of Macomb County.

“I know it’s not specific to just my area,” Marino told the House Health Policy Committee in late February. “It effects everyone’s districts in this room. It doesn’t discriminate based on age, gender, race, creed.”

AFSCME Council 25, which represents many government employees who are on the frontlines of dealing with people with substance abuse issues, is in support of the bill as well, said lobbyist Tim Greimel.

“It’s common sense to use a revenue stream and dedicate it to the important mission of mental health disorders,” he said. “This is by no means enough to adequately fund these programs, but it is a small step in the right direction.”

Last year’s Marino bill tried to take a portion of the year-to-year increase in revenue collected by the Michigan Liquor Control Commission. That bill (HB 5085) passed the House, 104-3, last year before dying in the Senate.

Part of the problem remains the opposition of the State Budget Office because it pokes a hole in the state’s General Fund revenue stream as opposed to creating a new funding source.

The bill moved out to the House Ways & Means Committee unanimously. Rep. Mary Whiteford (R-Casco Twp.) passed on the vote.

Health Advocates Say Teen Vaping Up 75% Over Last Year

Teenagers’ use of vaping products was referred to Feb. 26 in a House committee as an “epidemic” based on a study showing a 75 percent increase in the product over the last year.

The House Regulatory Reform Committee also learned that 36 percent of high school students reported using an electronic cigarette in the last 30 days of a recent survey.

Still, the American Heart Association, the American Lung Association and the American Cancer Society Cancer Action Network (ACSCAN) came out in opposition Feb. 26 to HB 4164, sponsored by Rep. Thomas Albert (R-Lowell), which would ban the sale and possession of e-cigarettes and vaping products to anyone under 18.

The associations would rather just have e-cigarettes defined as tobacco products, which are already illegal for minors to buy. Such a move would tax e-cigarettes—something the products’ manufacturers do not want.

The health advocates’ position did not sit well with Rep. Ryan Berman (R-Commerce Twp.).

“You guys are saying that for a number of years you’ve been trying to get something on the books. Now you are saying you want quick action. You are saying what you want is it to be a tobacco product. Is this not a step in the right direction?” said Berman.

“We are in opposition to this very particular definition. We absolutely support the idea that we need to keep it out of the hands of our minors,” said Dave Hodgkins of the American Heart Association.

Berman: “So why are you opposing this?

Hodgkins: “Because it does not define these products as tobacco.”

Berman: “Because it is not your perfect solution. Because it is not your perfect solution.”

Hodgkins: “It is not about that, it is about implementing solid public policy.”

Regulatory Reform Chair Michael Webber (R-Rochester Hills) said he thinks this is a case of “the perfect being the enemy of the good.” Albert would agree.

Albert said he wasn’t surprised the associations came out in opposition, saying they were responsible for former Gov. Rick Snyder’s veto of an earlier attempt to outlaw vaping sales to minors in 2014.

Albert said he has already tried to do exactly what the associations want, to define e-cigarettes as tobacco, last year but could not get a hearing for that bill in committee. Other attempts to ban sales to minors also failed.

Nothing in current law prohibits the sale of vaping products to minors, although several speakers from the industry said their companies will not sell to minors.

“It is getting to the point of silliness. This has to get done. We have, in my district, a fourth grader that was using it on a bus and the parents didn’t seem to think it was that big of a deal,” Albert said. “. . . We could nitpick on what’s a perfect deal and not do anything again for the next five years . . . we have to get these products out of the hands of our youth.”

Ken Fletcher from the American Lung Association said the associations have not been the stumbling block. The industry is desperately trying to give e-cigarettes a new definition. Andrew Schepers of ACSCAN said the federal Food and Drug Administration considers vaping products to be tobacco. Hodgkins said the U.S. Supreme Court deemed e-cigarettes tobacco products.

“We have seen all across the country youth smoking decline over the years and we were having great success, until recently,” Fletcher said. “The vaping, as mentioned already, has become an epidemic with a 75 percent increase in use among high school students just last year. So this is something that we are deeply concerned about . . . We want to see quick action. We want to see something be done right away. We have been advocating for a number of years that the easiest way to do that is just to classify it as a tobacco product.”

Although the vaping industry claims it is a healthier alternative to smoking, he said it has become a gateway to nicotine use and addiction for a new generation.

Matthew Kirkpatrick, of the e-cigarette maker TL Labs Inc., said he favors banning sales to minors, but does not believe vaping products should be defined as tobacco.

He noted that other smoking cessation tools like the patch, gum and lozenges contain nicotine but are not considered tobacco products. He noted cigarettes often have 21 milligrams of nicotine and the beginning patch has 21 mg of nicotine.

“The most popular milligram in electronic cigarettes is actually 3 mg, or zero in a lot of cases,” Kirkpatrick said. “The beauty of this system is that it allows people to wean themselves off and we’ve seen that as an industry. It has been really a huge thing. It makes going to work great when you get to have those opportunities to see these people leave that addiction behind.”

Rep. Frank Liberati (D-Allen Park) wasn’t buying it.

“If it looks like a duck, talks like a duck, walks like a duck, it is a tobacco product. There is no way to get around that,” Liberati said.

Webber said likely he will call a vote on bill, but wants further discussion with interested parties.

Rep. Rachel Hood (D-Grand Rapids) introduced legislation that would define e-cigarettes as tobacco products, but would also increase taxes on vaping equipment, cigarettes and other tobacco products.

Vaping Tax Proposal Increases Cig Tax $1.50 A Pack
Rep. Rachel Hood (D-Grand Rapids) wants to help people “walk away from nicotine addiction” and so is proposing increased taxes on cigarettes $1.50 a pack and smokeless tobacco, as well as taxing electronic cigarettes and vaping products the same as tobacco.

“I have a lot of compassion for folks who are addicted to nicotine, but I think the more we do to encourage people to move away from it the better. And for me, the increase in prices is one tool to do that,” Hood said.

Those in the industry say a tax hike will just spur people to buy out of state and provide an incentive for cigarette smuggling.

“Is an 81 percent tax on e-cigarettes going to reduce the consumption of e-cigarettes?” asked Scott Everett, a spokesman for a chain of retail stores that sell electronic cigarettes known as A Clean Cigarette. “I can tell you what it would do. If you end up taxing electronic cigarettes like you tax tobacco, you are going to end up with people not wanting to switch to electronic cigarettes and just keep smoking. That’s what it will result in.”

HB 4188, introduced in February by Hood, increases the $2-a-pack cigarette the tax by another $1.50. According to Hood’s office, the average price of a pack in Michigan is $6.44. The tax increase would bring the price to $7.94.

The bill would also increase the tax on other tobacco products (OTP)—chewing tobacco, snus, snuff, small cigars, etc.—from 32 percent of the sales price to 81 percent, and would treat e-cigarettes as tobacco products.

“E-cigarettes take advantage of new technology to deliver tobacco products to consumers in a different way,” Hood said. “Since they have come on to the market, I believe it is our responsibility, as representing the state, to make sure that they are appropriately taxed as tobacco products, which they are.”

Polly Reber, of the Michigan Distributors and Vendors Association, which represents wholesalers who supply tobacco products to convenience stores and gas stations, disagrees.

“There is no tobacco in e-cigarettes. That’s not what’s in there. It’s the nicotine. Those are really nicotine delivery devices. We don’t have a nicotine tax in the state of Michigan. It’s a cigarette tax,” Reber explained. “The nicotine isn’t even derived from tobacco because they can create it. It’s not derived from tobacco.”

Hood contends her bill would also help reduce the number of teens using vaping products, a subject directly addressed by Rep. Thomas Albert’s (R-Lowell) HB 4164, which bans the sale of vaping products to minors and prohibits the possession of such devices by anyone under 18. HB 4164 got its first hearing in the House Regulatory Reform Committee last month.

Hood said she supports Albert’s bill, but then so does Everett. He called it “an amazing thing” that the state still has not banned the sale of vaping products to minors yet.

Still for adults who are addicted, Everett contends e-cigarettes are a much better option.

“From A Clean Cigarette’s standpoint, as a company, their whole objective is to get people off of combustible tobacco. That is their objective. A lot of their customers, an overwhelming number of their customers, strongly feel that vaping is less harmful than smoking. And the proof is in the pudding. I’ve spent a lot of time in those stores where people have come in and said they feel so much better than they did when they were smoking,” Everett said.

“I don’t see these vapor products as cessation tools, especially if they are not prescribed under the advisement of a physician,” Hood said. “There are specific tools that are prescribed for tobacco cessation. We don’t want to tax those. We want encourage people to move away from tobacco use and nicotine addiction . . . If you are trying to deal with a nicotine addiction, it is best to do so with the support of your healthcare provider.”

Reber contended Michigan is still a high tax state for tobacco, but when the tax was higher than in to surrounding states a few years back, she said the revenue went down because people would just drive across the border and get their cigarettes elsewhere.

That affects the small businesses in other ways, she said. She noted that her association represents wholesales who collect the tobacco taxes and pass them on to state government. Since wholesalers send in the money before it is completely collected, it works out to “a guaranteed loan to the state of Michigan every month and it is almost a $1 billion,” Reber said.

“What we support is keeping the tax rate the same and doing more enforcement on it. But that doesn’t get very far,” she said.

Panel Says No To Medical Pot For ‘Chronic Aggressive Behavior’

A state panel Feb.22 voted against recommending “chronic aggressive behavior” as something that could be treated with medical marijuana.

However, the state Medical Marihuana Review Panel (MMRP) did vote to recommend cerebral palsy be added to the list of conditions allowed to be treated with medical marijuana.

Both conditions were presented in petitions to the MMRP, which votes to recommend to the director of Michigan Department of Licensing and Regulatory Affairs (LARA) whether to accept it or reject it as a qualifying condition.

LARA Director Orlene Hawks makes the final call within 180 days of the petition being submitted, making her deadline March 11.

At the meeting Feb. 22, no one from the public spoke on behalf of the petitions. MMRP Chair Dr. Eden Wells said the panel did not receive any input at a public hearing in mid-February on the petitions, or during the public comment period leading up to Feb. 22.

Both petitions had a Steve Miller listed on them, who listed an email address with the Komorn Law Firm, which has been involved in submitting previous condition petitions to the state.

The panel members—comprised of both doctors and non-physician members—said Feb. 22 that chronic aggressive behavior is not an actual diagnosis.

“Some of us here might have that diagnosis given to us by family members,” Wells joked, referring to chronic aggressive behavior.

On cerebral palsy, while some MMRP members agreed other conditions on the list might cover it, they still voted to recommend adding it to the list.

MMRP member Dr. Robert NOIVA said the petitioner had included primary literature on studies, as well as information on benefits and side effects, and ultimately said he was “comfortable” with recommending the petition.

The panel members who were present voted unanimously to approve cerebral palsy and reject chronic aggressive behavior, including Wells, the state’s former chief medical executive who is now working in a different position within the Michigan Department of Health and Human Services (DHHS).

Panel Dials Up 24/7 Mental Health Emergency Hotline

New legislation heard by a House committee Feb. 21 calls for a first-of-its-kind, 24-hour/7-day-a-week statewide hotline for those suffering a mental health crisis.

Under Rep. Mary Whiteford’s (R-Casco Twp.) HB 4051, the state would contract with a provider who could help police, a caregiver or a concerned citizens steer someone they fear is a threat to themselves or others to emergency treatment.

The Michigan CARES (Community, Access, Resources, Education and Safety) hotline could direct Medicaid patients to the community mental system or those with insurance to a nearby hospital’s psychiatric ward if there is an available bed.

Whiteford told the House Health Policy Committee that as it stands today, “Connections aren’t happening. More people are hurting themselves.”

Michigan saw 32.9 percent increase in suicides from 1999 to 2016, according to the Centers for Disease Control and Prevention reports. Nationwide, 2 million people with a serious mental illness are jailed each year, according to the National Alliance on Mental Illness.

The legislation is part of the last term’s House CARES Mental Health Task Force, chaired by House Health Policy Committee Chair Hank Vaupel (R-Fowlerville). The task force ended up kicking out more than 30 pieces of legislation with about half of them already signed into law.

On Whiteford’s bill, Vaupel said he has heard concerns that it could be duplicative or overlap some services, like those offered by the state’s 46 community mental health boards. However, he likes the idea of a statewide system to make the connection between the boards.

“One of the issues we face is that none of the CMHs are actually connected and the policies are not the same CMH to CMH,” Vaupel said. “So, you have someone with a mental health issue, who goes to another county, they may have totally different rules.”

Rep. Mike Mueller (R-Linden), a former sheriff’s deputy, told Whiteford that as a former law enforcement officer he routinely dealt with those with mental health situations. In his opinion, having an emergency line to call would be a benefit.

Last year’s final supplemental allocated $3 million to the Department of Health and Human Services to make the CARES hotline idea a pilot program in at least three areas of the state. The vendor would access to state information on available beds, suicide prevention assistance and substance abuse services.

Whiteford, a registered nurse who formerly worked in emergency rooms, said she would like to see the program spread statewide. As the new chair of the House DHHS Appropriations Committee, she said she would like to boost funding to $6 million to make that happen.

A couple private vendors have expressed interest in running the program. She said she would not be surprised if the United Way, which operates the 2-1-1 system, would apply for the contract, as well.

Jeff Wieferich of DHHS said the department supports the effort and “We believe this is something we can make happen.”

HB 4051 has support from AFSCME Council 25, the Ottawa Area Intermediate School District, the Michigan League for Public Policy, the Community Mental Health Association of Michigan and the Michigan Primary Care Association.

No action was taken on the bill in the House Health Policy Committee. The legislation is nearly identical to Whiteford’s HB 6202 from 2018, which did not get a vote in committee.

DOC Says Prisons’ Health Care Provider Being Held Accountable

Department of Corrections official Kyle Kaminsky told a House panel Feb. 20 that health care provider Corizon Health is being held “accountable” and “there have been some things that we have had to hold them accountable for.”

Corizon has a five-year, $715 million contract to provide health care, pharmaceuticals and mental health to Michigan prisons. The contract calls for penalties called “service level agreements” (SLAs) to be issued when there is a problem.

Kaminski and Acting Deputy Budget Director Lia Gulick were explaining prisoner health care to the House Appropriations Corrections Subcommittee as a follow-up to an old audit on health care in the prison system.

Asked if Corizon has addressed issues raised in previous audits, Kaminski said, “I would say overall they have. Obviously, we have had to levy some SLAs, which is indicative of the fact there were some problems that needed to be addressed. But we have been pretty aggressive with them.”

Kaminski said the department has levied $1.6 million in SLAs over the life of the contract so far.

“Please keep in mind this is a very large complex contract. To compare that to other contracts would be kind of an apples-to-oranges comparison,” he said. He said that amount comes to about 1 to 2 percent of the annual contract price.

Nonetheless, Kaminski said the department expects to take bids when the contract comes up in June 2020.

“It is our feeling that on a contract of this magnitude that the state should kind of constantly be sounding the market to see what has changed. Is there a better level of care at a lower price that we can accomplish? We are certainly expecting that we will rebid it next year. That does not mean that Corizon may not be potentially be the contractor again at that point,” he said.

Progress Michigan called for a review of Corizon in January because of a scabies outbreak at the Women’s Huron Valley Correctional Facility in Ypsilanti.

Kaminski said the entire facility and population was treated and prison officials are now going back through for another round of treatment.

He also said scabies had originally been ruled out when prisoners first began having rashes in late 2017.

Gordon Grilled On Fidelity To Medicaid Work Requirement
When Human Services (DHHS) Director Robert Gordon prepared his introductory remarks for a Valentine’s Day appearance before the Senate Advise and Consent hearing, he included reassuring words about upholding the Republican-passed Medicaid Work Requirement law.

“Last week, based on new evidence from Arkansas, (Gov. Gretchen Whitmer) released a letter expressing concerns about potential harm to Michiganders from the (work requirement) statute and saying she wished to work with the Legislature on changes that would protect coverage and at the same time encourage work and reduced red tape,” Gordon said. “At the same time, she made clear her commitment to follow the law and that is my commitment to you. I have taken an oath to uphold the Constitution of the United States and the Constitution of Michigan.

“I have a duty to federal and state laws,” he continued. “The work requirements are in state statute that I’m bound to follow.”

However, if Gordon believed that would put the issue to rest in the minds of the committee members he was mistaken.

Sen. Aric Nesbitt (R-Lawton) asked Gordon, would he “pursue administrative or other methods to reverse the Medicaid work requirements that were signed into law?”

“We will apply the law,” Gordon said forcefully.

“Will you give us a firm commitment that you will not attempt to change the law through administrative process or policy process internally in the department?” Nesbitt asked.

“We will all apply the law,” Gordon asserted. “We will not take actions that are inconsistent with the statute.”

Nesbitt also asked Gordon what standards he thought should be required for people to receive taxpayer-funded health care.

“I think health care is fundamental for people’s health and security,” Gordon replied.

Gordon then spoke about how difficult it is for most everyone to pay their bills and so on. Finally he said, “These things are for you (the lawmakers). I want to make very clear. The governor has expressed her views. I am here as a program administrator. That will be my job. As long as the law is on the books, I will enforce it.”

New Michigan Infant Mortality Prevention Drive In Pre-Natal Stage

State officials plan to launch a new strategy to help lower the number of Michigan babies who die before their first birthday.

“We’ve been working on this since the ’70s, but we’ve found new ways to address these problems,” said Ninah Sasy, a senior maternal child health strategist for the state’s Mother Infant Health and Equity Improvement Plan (MIHIP).

Michigan’s infant mortality is 6.5 per every 1,000 births, according to the United Health Foundation. That ranks 33rd in the nation. The national average is 5.9. New Hampshire’s rate is best with 3.9 deaths for every 1,000 births. Mississippi ranks last with 8.9 deaths for every 1,000 births.

There are also large differences among ethnic groups in Michigan. Asian infants die at a rate of 4.6 per every 1,000 live births. For white infants it is 5.2, for Hispanic infants it’s 7.0 and for Native American and multiracial infants it’s 7.5. African Americans have the highest infant death rate in the state at 13.8 deaths per 1,000 live births.

Former Gov. Rick Snyder signed off on the plan to reduce the deaths of infants younger than age 1 just before he left office. The Mother-Infant Improvement Plan was created to reduce preventable health problems in mothers and children.

“We’ve learned significantly in the last 10 years that the mother’s health greatly affects the survival of the baby, and the data supports that,” Sasy said.

Getting expectant mothers to their health appointments so they can hear the importance of prenatal health, breastfeeding and proper sleep positions is critical to the plan.

“Access to health care is a huge issue for rural and urban areas as well,” said Alicia Guevara Warren, Kid’s Count project director for the Michigan League of Public Policy. She helped create the plan. “Income plays a heavy role in the wellbeing of the mother and child.

“Maybe they live in an area that is not very safe so there’s high stress or they don’t have access to nutritional meals. We’re seeing a rise in infant deaths in the Latinx community, so we really need to look at the social determinants of health issues—sources of stress, food access, transportation access, and solve those,” Warren said.

The goal is lofty.

“There’s a vision of zero preventable deaths and zero health disparities,” said Lynn Sutfin, the public information officer for the Department of Health and Human Services.

The strategy advocates that infant and maternity care professionals work more closely and offer more home visiting programs.

There are three focus areas:

– Level ethnic disparities through tailored intervention to commonly occurring and pre-existing diseases and conditions like high blood pressure or genetic diseases.

– Address the primary causes of maternal deaths such as emergency C-sections, attention to pre-existing conditions, birth emergencies.

– Address the primary cause of infant death- premature birth and sleep-related deaths caused by parents or caregivers accidentally suffocating a child sleeping alongside them or incorrect placement of babies in their cribs.

While it is a state plan, health officials say the key to success is forming local partnerships.

“We can’t improve health outcomes unless everyone is on the same page,” Sasy said. “So that includes the fire department, who are often first responders, and transportation services because people in rural areas may have issues getting to health appointments.”

Community partners are as diverse as War Memorial Hospital in Sault Ste. Marie, St. Francis Hospital in Ludington, Henry Ford Hospital in Detroit and CEOs from hospitals across the state, she said.

Regional health groups have already helped inform the creation of the plan by holding town hall meetings across the state.

More than 500 partners will meet March 12 in East Lansing to plan how to meet the strategy’s goals.

(Contributed by Capital News Service correspondent Zaria Phillips)

Hanna-Attisha Tells Court: Lead In Water Means Lead In Kids’ Bodies

(FLINT)—The Flint pediatrician whose research helped expose the lead contamination crisis in Flint’s drinking water testified Feb. 8 that her research wasn’t necessary.

Dr. Mona Hanna-Attisha made her statement when Flint water Special Prosecutor Todd Flood asked for her opinion on whether elevated blood-lead levels in the city’s children was due to seasonal fluctuation or the city’s switch in drinking water source in April 2014 when it moved to the Flint River, which wasn’t treated.

Hanna-Attisha is a pediatrician with Hurley Medical Center and Michigan State University.

“You don’t even need the blood lead levels to know that there was a problem,” Hanna-Attisha replied bluntly. “None of my research was necessary. It should have ended when we knew there was lead in the water.

“If there’s lead in the water it’s going to get into the bodies of children. That was all the data I needed to form an opinion that it was going to be in the bodies of our children and more than expected,” she added.

Hanna-Attisha was on the stand in day eight of a preliminary exam, which began June 27, 2018, for Nancy Peeler, director of Department of Health and Human Services’ Program for Maternal, Infant and Early Childhood Visiting, and Robert Scott, DHHS’ data manager for Healthy Homes and Lead prevention program. Both are charged with misconduct in office and conspiracy, which are felonies, and misdemeanor willful neglect of duty in connection with the Flint water crisis.

Peeler is accused of hiding former DHHS’ epidemiologist Cristin Larder’s report on blood-lead levels and joining Scott to create a second report that falsely indicated no statistically significant rise in blood lead levels of children in July, August or September 2014.

No new court dates were immediately set.

The state’s only witness Feb. 8 was Hanna-Attisha, whose testimony echoed what she provided at preliminary exams for other Flint water defendants.

She explained that a friend who once worked for the U.S. Environmental Protection Agency told her at a dinner that without corrosion control in Flint’s water, “There’s going to be lead in the water.” As a result, Hanna-Attisha made it her quest to learn how it affected the city’s children.

The doctor said she met roadblocks with receiving data from DHHS, so she used hospital data and she announced her results—that the blood-lead level in the children had increased—at a Sept. 24, 2015, press conference.

Flood asked Hanna-Attisha if she had seen Larder’s report, which analyzed three months of data and identified an increase in blood lead levels. Larder concluded the issue warranted additional investigation, but she did not identify a cause.

When Hanna-Attisha said she hadn’t seen Larder’s results, Flood asked if she could have used Larder’s report in her research.

Hanna-Attisha quickly replied, “Absolutely.”

“It shows an elevation in blood-lead levels of children during the time of the Flint water (crisis),” she said.

Lansing Lines is a cooperative feature presented by MIRS, a Lansing-based news and information service and Healthcare Michigan.