Health Policy Lends Resolution Support To ACEs Initiative
Adverse childhood experiences (ACEs), according to a growing body of research, can have long-term consequences on physical and mental health and can even shorten life expectancy, Richard Murdock of the Michigan Association of Health Plans Foundation told the House Health Policy Committee Jan. 30.

“According to the most recent Michigan data, nearly 70 percent of Michigan’s adult population reported having at least one adverse childhood experience and nearly 1 in 5 adults reported having four or more ACEs as a child,” Murdock said. “Awareness is absolutely key, but raises the question of what do we do? What’s next? How do we begin to identify or establish resiliency?”

The original study identifying the long-term impacts of ACEs on health was conducted by the Centers for Disease Control and Prevention and Kaiser Permanente back in the 1990s, identifying 10 categories of traumatic experiences children suffer that leave emotional scars. They are physical abuse, emotional abuse, and sexual abuse; physical neglect and emotional neglect; and five different forms of household dysfunction, mental disease, mother treated them violently, divorce, having an incarcerated relative and substance abuse.

Problems these events can cause are varied. Adults are 141 percent more likely to be depressed if they’ve had one or more ACEs; 46 percent more likely to binge drink; 83 percent more likely to have COPD; and 69 percent more likely to have asthma.

“What we learned from the study is the significant impact that adverse childhood experiences has on society,” Murdock said. “You will see things going on with it, but no other state is taking it on the way we have. But we also should realize that it is not going to be a cookie cutter. It is not going to be a one-solution-fits-all.”

So far, the efforts to build resilience—the ability to adapt well, or “bounce back” from difficult life events—among Michigan residents has all been the work of the MAHP Foundation.

Currently there is no line item in the budget to address ACEs or their impacts, said Rep. Hank Vaupel (R-Fowlerville). He hopes to change that soon.

What the MAHP Foundation did get today was a 19-0 vote on Senate Concurrent Resolution 0008, sponsored by Sen. Curt VanderWall (R-Ludington) declaring that ACEs constitute a critical health issue and urging the state legislators and leadership to commit to an ongoing strategy to significantly reduce ACEs and their impacts.

It also encourages the governor to issue an executive directive requiring agencies to assess whether their programs reduce ACEs. It also asks for an annual report to the Legislature about the state’s progress reducing ACEs.

Vaupel’s similar HCR 0002 has already passed the House and awaits action in the Senate.

Gov Signs Bill Allowing Telepharmacies
People could fill their prescriptions at “remote pharmacies,” staffed by a pharmacist available through a live video feed in a bill signed into law by Gov. Gretchen Whitmer Jan. 24.

SB 0340, sponsored by Rep. Curt VanderWall (R-Ludington), allows parent companies to operate telepharmacies supervised by a pharmacist at a parent pharmacy if located in Michigan.

It also sets requirements for telepharmacies to meet in order to be approved by Michigan Department of Licensing and Regulatory Affairs.

Supreme Court Won’t Expediate ACA Case
Attorney General Dana Nessel Jan. 21 called the U.S. Supreme Court’s denial of a motion to expedite consideration of the Affordable Care Act “disappointing.”

The court’s decision makes it unlikely that the court will hear the case, California et al. v. Texas et al. before the November election.

“I remain hopeful that the Court will ultimately take the case so that we can avoid the unnecessary uncertainty caused by allowing the case to return to the district court,” Nessel said. “The U.S. Supreme Court should rule the Affordable Care Act is constitutional and may be applied to protect the millions of Michigan residents who rely on it for their health care.”

Dianne Byrum, state director for Protect Our Care Michigan, said she wanted to court to rule on the ACA because, “We want the issue front-and-center in this campaign cycle and let the American public express their opinion.”

In a 2-1 decision, the U.S. Court of Appeals Fifth Circuit struck down Obamacare’s insurance mandate, sending the case back to District Judge Reed O’Connor to determine if other parts of the federal health care law can stand without the mandate.

The case was initially filed in 2018 by 20 Republican-led states.

Earlier last month, Nessel joined 18 other Democratic-led states to file a petition asking the court to consider the case on an expedited basis.

Health Care Access Found By Volunteer Agency As State’s Most Pressing Issue
Access to health care is the most pressing issue affecting them, according to those questioned by the Michigan Community Service Commission as it came up with its 2020-22 State Service Plan.

In all, close to 140 of the 1,356 of those who responded to the CSC’s “listening tour” mentioned health care, followed closely by mental health care and affordable housing access, which both received roughly 105 responses. More than 450 came from in-person discussions and 906 more came online.

The survey also found that “limited staff capacity to recruit and manage volunteers” was the top challenge facing volunteerism in Michigan. Other issues include volunteers only interested in “episodic volunteering” and general difficulty recruiting people willing to donate their time.

Respondents opined that conducting a public awareness campaign was voted as the best to expanding volunteerism. “Providing funding and connections to resources” was listed second as the most popular idea.

The results appeared in the CSC report personally released Jan. 15 at the Capitol by Gov. Gretchen WHitmer, who was joined by members of the state agency charged with overseeing volunteerism in the state. The commission includes Whitmer’s 18-year-old daughter, Sherry Shrewsbury, as an “honorary designee.”

As far as the 2020-22 Service Plan, the commission’s top goal will be to “strengthen statewide infrastructure to support national service, volunteerism, mentoring and disaster services.

Part of that will be to create a “corporate volunteer partnership network” and create a special council to connect Michiganders with national service programs.

State Sues 17 Corporations Over PFAS Contamination
The state of Michigan filed suit Jan. 14 in Washtenaw County against 17 different entities as a way to cover the cost of environmental and public damages caused by toxic per and polyfluoroalkyl substances collectively known as PFAS.

The state’s lawsuit argues chemical giants DuPont and 3M, among others, deliberately concealed PFAS’ dangers and withheld scientific evidence. The companies also allegedly “recklessly sold,” distributed and disposed and used PFAS-containing materials in a way that they knew would contaminate natural resources and expose Michigan residents to harm.

Nessel tipped her hand that this type of legal action was coming.

“We bring this action today on behalf of the people of Michigan,” Nessel said. “It is our responsibility to protect our residents and our state’s natural resources and property by preventing and abating hazards to public health, safety, welfare, and the environment—and by placing the responsibility for this massive undertaking with those responsible for creating the problem.”

Joining Nessel at the announcement were former Attorney General Frank Kelley, Gov. Gretchen Whitmer and Department of Environment, Great Lakes and Energy director Liesl Clark.

“Michigan has been established as a national leader in identifying, monitoring and addressing contamination caused by PFAS,” Whitmer. “As such, we must continue to protect communities across our state from harmful PFAS chemicals by holding polluters accountable. Future generations of Michiganders are counting on us to get to work today.”

3M officials responded that it acted responsibly in containing PFAS chemicals and will “vigorously defend” its record on environmental stewardship. It said the company has placed “thousands of documents in the public domain, including more than 150 published studies conducted by 3M and other researchers about the environmental and public health effects of PFAS.

“3M did not and will not distort the science,” reads the statement, which includes a link to this site.

Dupont spokesperson Dan Turner said the company was “extremely disappointed” by the suit and that it does not make PFOA, PFOS, GenX or the fighting foam that’s central to the claim of the PFAS contamination suit.

“Across our portfolio, DuPont’s use of other PFAS is a small fraction of the total PFAS used in the world,” Turner said. “While our use is extremely small, we’re actively pursuing alternatives to PFAS where possible in our manufacturing processes.”

For what remediation responsibilities it has, DuPont is committed to upholding “the highest standards,” he added.

Nessel’s suit argues that the defendant companies knew or should have known that:

– PFAS persists in the environment and that they do not degrade

– PFAS accumulate in both animals and humans exposed to the chemicals

– PFAS are potential or confirmed carcinogens, and

– continued manufacture and use of PFAS would inevitably result in continued and increased levels of PFAS getting into the environment and into people’s bodies.

The suit also argues that the companies knew that PFAS chemicals are toxic and impose environmental risk, but failed to release that information to the state of Michigan or its residents.

“Chemical companies have known for decades that PFAS compounds don’t break down, build up in the human body, and exposures can lead to illness, yet they have never warned Michigan consumers or manufacturers of the unintended consequences associated with using these ‘forever chemicals,” said Clark.

PFAS chemicals have been used at military installations as fire-fighting foam, as well as in the production of leather goods, clothing, and fast-food wrappers among other consumer products.

The state contends that PFAS is connected with decreased fertility, pregnancy-induced hypertension, liver damage, thyroid disease, abnormal cholesterol levels, immune system problems and her rates of cancer.

Other companies being sued include:

– The Chemours Co., a spinoff of DuPont, and its subsidiary The Chemours Co. FC, LLX

– Corteva Inc., another DuPont spin-off which was part of defendant Dow DuPont

– Dyneon LLC

– Archroma entities

– Arkema entities

– AGC Chemicals Americas Inc.

– Daikin Industries entities

– Solvay Specialty Polymers USA LLC, and

– Asahi Kasei Plastics North America Inc.

The Attorney General’s office has hired special outside counsel to pursue the litigation, noting that it was more efficient to do so than to “recreate the wheel” with in-house attorneys. Nessel said those outside firms will work on a contingency basis and will not be paid hourly. Recall that former Attorney General Bill Schuette chose to pay a special Flint prosecutor per hour, a decision that was criticized.

The firms handling the litigation are DiCello Levitt Gutzler LLC, out of Chicago, Keating Muething & Klekamp PLL out of Cincinnati, Ohio, and Fields PLLC out of Washington D.C.

DNR Wants Enbridge To Pony Up Information On Line 5
Enbridge is being given 30 days by the Department of Natural Resources to respond, with documentation, specific information on its Line 5 under the Straits of Mackinac as the department reviews the 1953 easement granted back in the day by the Michigan Conservation Commission.

DNR Director Daniel Eichinger asked Enbridge in a letter to go back in time to detail any damage or leaks suffered to the line between the time it opened in 1953 to the present. He also wants information on any communications with the state about the damage, whether that is a letter, email or voicemail.

Information on anchor strikes, the pipe’s curvature, investigations and any corrective action taken in regards to the 66-year-old pipe is also being requested

The letter is part of the DNR’s review of the pipeline as ordered by Gov. Gretchen Whitmer last June. News of the letter was heralded in a press release by the environmental group FLOW, For the Love Of Water.

“It’s a welcome sign that Director Eichinger and his staff appear to be wrapping up their Line 5 investigation by asking for all other information and documentation that Enbridge has in its possession or control,” said Kelly Thayer, FLOW’s deputy director. “At the conclusion of this process, these serious and continuing violations of the easement by Enbridge should trigger the state to shut down the dangerous dual Line 5 oil pipelines in the Great Lakes before it’s too later.”

Enbridge spokesperson Michael Barnes said the company had received the state of Michigan’s information request on a line that he said has been “operarting safely and reliably since it was constructed more than 60 years ago.”

“The pipeline is an essential part of Michigan’s energy infrastructure system, helping Michiganders heat their homes and powering business across the State and region,” Barnes said. “We are committed to making a safe pipeline even safer by investing $500 million in the construction of a tunnel under the Straits to house the pipeline—thereby further protecting the waters of the Great Lakes and everyone who uses them.”

Panel Probing Expanding Cardiac Catheterization Options
More cardiac catheterization procedures could take place at facilities other than hospitals under legislation currently before the Senate Health Policy and Human Services Committee. SB 0675, sponsored by Sen. Dale Zorn (R-Ida), would eliminate Certificate of Need for such operations.

“Modern medicine can offer the same, or even better care, than a hospital at a much lower cost at outpatient settings,” Zorn told the committee last week. “This outpatient care has been taking place for years with patients receiving knee replacements and spinal surgery, just to cite a few.”

“The Center for Medicare and Medicaid Services has had such success with the quality outcomes and cost reductions that they have recently expanded the Current Procedural Terminology code to cover cardiovascular procedures such as cardiac implants, like pacesetters, and heart catheterizations with simple stinting,” Zorn added.

Kyle Sheiko, corporate operating officer for Dearborn Cardiology, told the committee he had a unique perspective on SB 0675.

“I was corporate executive for the cardiac service centers of the Detroit Medical Center’s four hospitals,” Sheiko said. “It was my job to thwart these kinds of initiatives with our corporate government relations team. We’d lobby that these kinds of procedures are not safe outside of a hospital or that there is no oversight for these procedures in an (Alternative Surgical Center).”

According to Sheiko, his opinion changed after the Michigan Certificate of Need Commission, in 2016, allowed the procedures to be performed in hospitals without cardiac surgery back-up. Fifteen hospitals that took advantage of that change.

“Guess what happened?” Sheiko said. “The sky didn’t fall. The patients were served with great success, despite not having cardiac surgery back-up.”

However, Cheryl Wieber, executive director of Heart and Vascular Services for Munson Healthcare, testified in opposition to SB 0675.

“We are able to serve patients at 10 outpatient locations throughout Northern Michigan,” Wieber said. “At Munson Healthcare, we employ 21 cardiologists and nine outpatient advance process providers that together last year performed 40,534 outpatient clinic visits of which nearly 46 percent were seen in regional outpatient clinics.

“Based on our work, we do not believe that the Certificate of Need program as it exists today, is a barrier to ensuring access of care to cardiovascular patients,” she continued. “At Munson Healthcare outpatient clinics we actively treat patients with a wide range of cardiovascular conditions. More than 6,000 cardiac catheterizations and more than 600 cardiac thoracic surgical procedures are performed on patients who trust us with their lives.”

Wieber went on to assert that it takes a team of experts with a proven track record cooperating together to provide the level of care required to ensure the safety of patients undergoing cardiac catheterizations. She also said enactment of SB 0675 could accelerate the number of cardiologists migrating to outpatient settings, where work hours are more regular, leading to shortages of cardiologists assigned the inpatient facilities, potentially decreasing staff available for emergency situations.

Committee Chair Curt VanderWall (R-Ludington) asked Wieber if she was aware of studies showing that cardiac catheterizations performed at outpatient sites are as safe or safer than those performed in hospitals.

She said her experience and information contradicts that.

Zorn introduced Elias Kassab, interventional cardiologist at Wayne State University, to the committee. Kassab, who said he has been a cardiologist 32 years, performed the two cardiovascular procedures on Zorn 11 months ago in a hospital setting. Zorn discovered afterwards, via Kassab, that the same procedures could have been performed at an outpatient site.

“We have observed a significant decrease in complications—validated by the Blue Cross Blue Shield of Michigan cardiovascular consortium,” Kassab told the panel, in reference to surgeries being done at outpatient facilities. “In lower risk cases, the outcomes were similar to those in hospitals, however, the anatomically sicker patients had substantially less complications than the hospitals.

Kassab attributed this, in part, to the patients receiving care from the same staff before, during and after the procedures instead of being subjected to changing staff shifts at hospitals; also use of ultrasound to determine access sites on the patients’ bodies, and less chance of infection than would be the case in hospitals.

Krishna Jain, interventional cardiologist at the Center for Clinical Research of Western Michigan University, also testified in favor of SB 0675.

“An ASC is always paid at a lower rate than a hospital-outpatient department,” Jain said. “We’ve performed more than 12,000 procedures in the office setting with results comparable or better than in hospital settings. Our patient satisfaction in two studies measured at 98 percent and 99 percent.”

Jain told the committee that one of the reasons the procedures performed in ASCs or offices garnered better results than those performed in hospitals is because the physician “bears a greater burden” for what takes place.

“This results in better patient selection and the team consists of members handpicked by the interventionalist,” he said.

In addition to Munson Healthcare, SB 0675 is opposed by Trinity Health, Spectrum Health, Blue Cross-Blue Shield of Michigan, Henry Ford Health Systems, McLaren Healthcare and Sparrow Health.