Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

Mental Health Crisis Management Program Brought To Teachers Under Bill

The Michigan Department of Education would need to create a professional development course on mental health crisis management and rapid response for educators under Sen. Sylvia Santana’s (D-Detroit) latest legislation.

Already, the MDE has advocated for the doubling—at a minimum—of funding of intermediate school districts (ISDs) for distributing mental health amenities to students. Under Santana’s SB 0321, the department would join forces with the Michigan Department of Health and Human Services in fostering a program that equips teachers for mental health challenges.

“The mental and emotional toll of this stressful time will stay with our children for the rest of their lives, and it will have a profound effect on their growth,” Santana said in her press release on the bill. “If we want all students to reach their potential, we need to ensure they’re not just physically healthy, but mentally healthy, too.”

In a study led by Daniel Whitney, a postdoctoral fellow in the Department of Physical Medicine and Rehabilitation at the University of Michigan, 17.6 percent of Michigan children and adolescents have been diagnosed with either depression, anxiety or Attention Deficit Hyperactivity Disorder (ADHD).

Recording approximately 100,000 Michigan youths between the 6 and 17 diagnosed with a mental illness, the research found that 40.5 percent are not receiving treatment—not too distant from the 50 percent in the national observation.

“I think there are legitimate reasons, the social context of our communities nowadays is more isolating and there’s more validation from social media. And then the question is are we too sensitive or are we over-diagnosing and if you talk to mental health professionals in the clinical setting, these professionals still say that there’s underdiagnosis of these conditions,” said Whitney on the Stateside podcast with Michigan Radio.

Additionally, through the national lens, and featured in Santana’s press release, half of young Generation Z teenagers recorded in the 2020 American Psychological Association “Stress in America Survey” expressed that the COVID-19 pandemic “severely disrupted their plans for the future.”

Zooming in on those aged 13 to 17 years-old, 51 percent of these recorded youths admitted that planning for the future felt impossible within the COVID-19 crisis.

“The potential long-term consequences of the persistent stress and trauma created by the pandemic are particularly serious for our country’s youngest individuals,” the report reads. “We need to act right now to help those who need it, and to prevent a much more serious and widespread mental health crisis.”

During a Feb. 23 meeting of the Senate Education and Career Readiness Committee, Michael Peters, a parent at Plymouth-Canton Community Schools, told the committee that a high school student from the district had committed suicide the day before.

“This was preceded by weeks and months of pleading from this person’s mother to address the issues of mental health, of isolation, of the substandard learning experience and his calls went unanswered, and now he is gone,” Peters said.

That February morning, the mother of the deceased student had contacted Peters’ wife, begging that they speak to the committee on behalf of her son.

Peters said it was a tragic case.

“We do have an epidemic of mental health going on in these areas where remote learning continues, and just because it’s hard to measure doesn’t mean that it doesn’t exist.”

72.4% Of Michiganders Oppose Gordon’s Resignation Payment

A Marketing Resource Group poll found 72.4 percent of 610 likely Michigan voters opposed Gov. Gretchen Whitmer’s office providing a $155,000-plus payment to the former health department director upon his resignation.

Michigan Rising Action commissioned the Mar. 15-18 poll. This limited-government and low-taxes group showcased the poll on its website, which also proclaimed that 63.1 percent of Michiganders opposed Whitmer’s handling of COVID-19 in nursing homes.

The agreement between previous Michigan Department of Health and Human Services Director Robert Gordon and the state has been characterized by some as “hush money.”

“Whitmer should immediately disclose why this shady financial arrangement with the person who directed shutdowns and oversaw nursing home policies was made and what they are trying to cover up,” said Tori Sachs, executive director of the organization.

MI Still Leads Nation With New COVID-19 Cases

Michigan continues to lead the country in new COVID-19 cases by population, transcending 700,000 cases and acquiring 10,293 new ones as of early April.

The Monday after Easter Sunday of 2020, the state experienced its second consecutive day of fewer than 1,000 cases reported, with Joneigh Khaldun, the state’s chief medical officer, explaining she was starting to see early signs of a plateau in the rate growth of COVID-19 cases in the state of Michigan” at the time.

For Easter Monday 2021, The New York Times reported seven Michigan metropolitan areas as being within the Top Ten with the largest number of new cases—in relevance to their populations—in the last two weeks spanning late March and early April. These included:

– Jackson with 1,724 recent cases

– Detroit with 40,453 recent cases

– Flint with 3,614 recent cases

– Monroe with 1,297 recent cases

– Lansing with 3,953 recent cases

– Owosso with 550 recent cases

– Battle Creek with 953 recent cases

The Bay City metro area was ranked 11th with 686, Kalamazoo-Portage in 12th with 2,225, Grand Rapids as 16th with 6,730 and Holland in 20th with 726 recent cases.

According to the Michigan Department of Health and Human Services, the state’s total amount of cases stands at 702,499 since COVID-19 initially emerged in March 2020 and 16,239 deaths attached to the virus.

On April 3, more than 8,000 fresh cases were tallied.

Utilizing these numbers, WXYZ reported 84 new COVID-19 outbreaks have been reported within schools – 40 of those occurred within Metropolitan Detroit and 20 happened specifically in Oakland County.

Hospitalization saw a rise at the end of Easter week with 2,766 adults being admitted with COVID-19. This was a 60 percent boost from the earlier week.

The Detroit News reported that “hospitalization for confirmed cases of COVID-19 are now increasing at a faster rate than before Gov. Gretchen Whitmer shuttered indoor dining and suspended in-person high school classes in the fall.”

Prescribers Didn’t Check Patient History Before Doling Out 4.3M Scripts In ’19 APR1

A third of 13 million controlled substance prescriptions written in 2019—or 4.3 million—were done without the prescriber first checking the patient’s prescription history report in a state database, a state audit reported April 1.

The Michigan Automated Prescription System, or MAPS, is a web-based system comprised of a history of prescriptions dispensed in Michigan. It was established to prevent the abuse and diversion of controlled substances and was seen as a tool to cut down on opioid-related deaths.

Since 2018, prescribers were required to check MAPS for a patient prescription history report before prescribing anything exceeding a three-day supply, according to an Office of the Auditor General report.

Yet, prescribers did not check that report within seven days of writing 4.3 million prescriptions, or 33 percent, of the 13 million prescriptions written in 2019.

For veterinarian prescribers, 32% of the 264,312 of the prescriptions written between June 2018 and the end of 2019 also had not been done in consultation with the MAPS patient reports.

The Michigan Department of Licensing and Regulatory Affairs checked on the compliance with the MAPS report requirement when complaints or tips came through, but the audit noted that LARA “had not analyzed compliance for all prescribers” and that LARA “had not established a systematic process to identify and resolve prescriber noncompliance.”

LARA acknowledged in its response to the finding that it “should and can develop a more systematic and operationalized process to ensure licensed prescribers met” the requirement to check MAPS before issuing a prescription.

And the OAG said the agency was working with the MAPS vendor to “refine the MAPS functionality to properly identify noncompliant prescribers.”

LARA, in its response, also detailed its efforts to “educate, warn, then enforce” the requirements tied to MAPS, which included the issuance of 2,315 “non-disciplinary warning letters” to prescribers who appeared to be issuing prescriptions but not registered with MAPS in 2019, along with another 831 of those letters in 2020.

The department said it has issued administrative complaints against licenses regarding failures to comply with the MAPS use requirement.

Other findings from the audit report on MAPS included:

– Roughly 680 licensed medical professionals “likely had inappropriate access to MAPS” and 64 former state employees had access to the system for various amounts of time after their employment with the state had ended.

– Six MAPS employees were given “unmonitored ability” to create, edit, delete or disclose confidential prescription data.

xxxWhitmer Not Bringing Up New Restrictions As Case Numbers Climb

If Gov. Gretchen Whitmer’s Michigan Department of Health and Human Services is going to turn up the dial on further restrictions in the face of a “third surge” of COVID-19 cases, they’re not letting on to the fact.

The governor never mentioned lower capacity limits in restaurants or statewide moves back to remote learning this morning on CNN in a rare recent interview she’s done on this subject.

She argued that Michigan went through some of the nation’s tougher restrictions when vaccines were not widely available, and Michigan saw low infection and death rates than other states.

Now that many of the restrictions have loosened, the case numbers are admittedly climbing. The difference is the vulnerable populations have been—by and large—vaccinated, and many people are in the process of getting a shot if they haven’t received it already.

Vaccinations are now hitting 100,000 a day in Michigan, with 4.2 million doses given to date, the Governor’s office announced in early April.

Still, Michigan’s seven-day case rate per 100,000 people is at 361.5, the highest in the nation, according to the Centers for Disease Control.

In speaking to CNN, the governor noted that the rise in Michigan’s cases needs to be kept in perspective. Some states with infection rates in the double digits in January may now be down slightly but still be fairly high.

She credited the tighter restrictions for keeping the numbers low when not as many people were vaccinated.

“You do see 50 percent increases from 3 percent to 6 percent, but still 3 percent was still a lot lower than a lot of the rest of the country when other states go from 15 percent to 14 percent, it looks like they’ve got a great positive trend, so I think perspective is really important,” she said.

According to CDC statistics, compared to five other states of similar size, Michigan’s daily case numbers were notably lower for about 70 days earlier this year.

While Michigan had a seven-day average of 2,747 new cases in mid-January, New Jersey, Ohio, North Carolina, Virginia, and Pennsylvania all had seven-day averages of between 4,000 and 7,000.

Also, during that time period, Michigan’s death numbers were below the other states, except for Virginia, which doesn’t appear to have been regularly keeping up reporting their deaths given their erratic reporting numbers.

Asked by the CNN anchor if it was a “mistake” to roll back the restrictions to the degree they did, Whitmer pointed out Michigan didn’t have vaccines when the fall restrictions began. There are three now.

“We’ve got a high proportion of variants, and that means coronavirus spreads faster,” she said. “They are more contagious, and we’re seeing that, whether it is youth sports, or it is the re-engagement of some of our restaurants, etc. More activity means more spread.”

The comments would seem to flip the script on legislative Republicans’ stance of linking restrictions on restaurants, schools, and other sectors of life to hard numbers.

For example, under SB 0250, which the Senate passed, restaurants could only be allowed to be at 25 percent capacity given that Michigan’s infection rate is 13 percent. The current limitations are at 50 percent capacity.

Senate Republican spokewoman Abigail Walls said the bill is designed to provide the hospitality industry with some certainty on what metrics would trigger restrictions.

“That’s what following the science to protect lives would be,” Walls said. “We, and many others along with us, have been asking for metrics for a year now, and none have been provided.”

Asked if that meant the Republicans are for restrictions, given the case numbers, Walls responded that the particulars could be adjusted. Still, the fact remains that the governor has not put forward hard numbers attached to her policy decisions.

She makes vague references to various pieces of data but doesn’t elaborate on the combinations.

The fluid dynamic drove Sen. Aric Nesbitt (R-Lawton) to tweet, “She says she has been using science and data the whole time . . . or . . . has she actually been using political science and polling data?”

Emails: DHHS Officials In Early Feb ‘Unaware’ Gov’s Office Pursued Gordon Deal

The legal counsel for the state health department recommended telling a reporter the department was unaware of a severance agreement for former director Robert Gordon, according to emails and messages obtained by MIRS.

That advice relayed to Bob Wheaton, public information officer for the Michigan Department of Health and Human Services, came after the governor’s chief legal counsel had already offered Gordon the opportunity to discuss an agreement the same day Gordon announced his resignation Jan. 22.

Even after the agreement was signed by Gordon on Feb. 22, a reporter’s inquiry the very next day about a severance agreement got this response from the governor’s office: “Director Gordon resigned and the governor accepted his resignation. She is grateful for his service.”

Wheaton told MIRS the DHHS didn’t come into possession of a signed and finalized copy of the Gordon agreement until Feb. 23. Wheaton himself said he didn’t know Gordon had been offered an agreement until Feb. 24 when he saw it in an email that was going to be released as part of a Freedom of Information Act request.

The Gordon agreement wasn’t made public until March 1, which called for the former DHHS director to be paid $155,506 in exchange for Gordon releasing any claims against the state. A provision requiring the parties maintain confidentiality about the departure has since been waived.

On Jan. 29—a week after Gordon resigned and was offered the opportunity to discuss a separation agreement–Detroit Free Press reporter Dave Boucher emailed the DHHS about whether Gordon had been “paid any kind of severance” when he resigned.

Wheaton sent the question to the director of human resources for the department, Mike DeRose, who said that day he didn’t “know definitively one way or the other,” according to the emails obtained by MIRS.

As Boucher continued to follow up on his question over several days in late January and early February, Wheaton sent a text message to Tiffany Brown, communications director for Gov Gretchen Whitmer. Wheaton told her that DeRose had advised him to check with the Governor’s or the AG’s office about the severance agreement question.

“Could the department just tell Craig you don’t discuss personnel matters??” Brown said, likely referring to Craig Mauger of The Detroit News.

Wheaton replied: “If there’s a severance I don’t know how we can do that. It’s taxpayer dollars. It’s FOIAble, so if there is a severance it will come out eventually.”

Brown and the governor’s office did not respond to a request for comment on this story.

Wheaton sent more texts to Brown over the course of several days seeking advice on how to respond. Brown replied a few days later with, “I don’t have anything different to share from the feedback provided on Friday,” and then suggested Wheaton have the DHHS legal counsel get with the governor’s legal counsel.

On Feb. 1, Wheaton texted Brown again: “Our legal director recommends I respond that the department is unaware of a severance agreement. Can you let me know your thoughts on that?”

The texts MIRS received show no reply from Brown.

By Tuesday, Feb. 2, Wheaton sent his email response to Boucher’s question from Jan. 29: “We do not discuss personnel matters.” Boucher asked why it took several days to get a no comment. Wheaton said the department had to discuss it internally.

Wheaton confirmed later in another email that “Matthew” – likely Matthew Rick, senior deputy director of the legal affairs administration for the DHHS—had advised him to say “the department is unaware of any severance agreement with Robert Gordon” on the Boucher question.

Wheaton said he confirmed DHHS Director Elizabeth Hertel “that this is correct.” He also said he had reached out to Brown and hadn’t heard back.

By Feb. 22, the agreement calling for a $155,000 payout to Gordon had been signed by the former director and Mark Totten, the governor’s chief legal counsel.

In a Feb. 23 email, another Free Press reporter, Gina Kaufman, asked Wheaton directly if the state has any separation agreements tied to Gordon.

About 10 minutes later, it’s Brown who replies to Kaufman with “Director Gordon resigned and the governor accepted his resignation. She is grateful for his service.”

Kaufman replies: “What I’m asking for, though, are any separation records related to his departure. Is there any documentation related to his resignation?”

In another text message from Brown to Wheaton that same day, the Governor’s communications director asks, “Hasn’t the department fulfilled a request for any docs related to” Gordon’s resignation, adding, “if she wants to know if any other docs exist she can submit a FOIA?” referring to the Freedom of Information Act.

Wheaton responded that “to the best of my knowledge, MDHHS doesn’t have a resignation letter and doesn’t have a separation/severance agreement.”

Wheaton sent an email to Kaufman on Feb. 24 inviting her to file a Freedom of Information Act request.

Meanwhile, also on Feb. 23, an email from Michelle Lange – chief deputy of the governor’s chief operating officer – went to Farah Hanley, senior deputy director of financial operations for the DHHS.

Lange, referencing an attached copy of “the settlement agreement” asked Hanley to process the payment involved with the settlement. She also advised that the document is to be kept confidential and only shared on an as-needed basis.

“Again, thank you for your discretion in processing this payment,” Lange told Hanley.

In another email, Gordon himself emails the agreement he made with the state from his personal email to Rick, the DHHS legal counsel, on March 1. Rick then forwards it to Wheaton.

By March 1, Wheaton provided a heads up to the AG’s office that the department’s FOIA office would be giving Mauger of The News emails to and from Gordon, including one where Gordon was informed he could talk to the AG’s office about a separation agreement, “so Craig may be reaching out to you about that,” Wheaton said.

Later in that email chain, AG spokesperson Kelly Rossman-McKinney said she “expedited” Mauger’s request for the Gordon agreement and that he also would be getting it that same day, March 1.

Wheaton then proceeded to email the separation agreement directly to the Free Press reporters who had inquired about it. From there, at least three other reporters – including a MIRS reporter – asked for and received the Gordon separation agreement via email and got it from Wheaton on March 1.

State To Providers As Cases Climb: ‘Vaccinate Anyone Over 16 Now If You Can’

The state is telling anyone who can vaccinate people 16 and older now to go ahead and do so, as Michigan’s COVID case numbers continue their climb toward the top of the nation.

The Centers for Disease Control and Prevention has Michigan atop every state in the seven-day case rate per 100,00 people, at 361.5.

The New York Times has Michigan at the second highest cases per 100,000 people in the last seven days, just behind New York. In raw numbers, Michigan is third with 5,117 cases as the daily average over the past week, behind Florida and New York.

Another 5,177 confirmed cases were added to the state totals today, the fourth time in the past five reports that the number of cases has been above 5,000.

The 48 deaths added is the third time since March 20 that the daily death report has risen above the 40 mark. The totals for the pandemic now stand at 665,948 cases and 16,082 deaths.

The state today announced that vaccine providers with the capacity to vaccinate all individuals ages 16 years and older may do so at this time, even though April 5 was the date previously set for those 16 and up and not previously eligible to get the vaccine.

Gov. Gretchen Whitmer’s office announced the feds are increasing Michigan’s allocation of vaccine doses by 66,020 in next week’s shipment, bringing Michigan to a weekly record high of 620,040 vaccines next week.

Just over 33 percent of people over 16 in Michigan are vaccinated in part, or 2.6 million people.

As part of the efforts to contain the COVID spread, the state today said more than 1.4 million antigen tests have been sent to long-term care facilities, and more than 72,000 free tests have been conducted at neighborhood testing sites in socially vulnerable communities, according to a press release.

Free post-spring break testing pop-up sites are planned for school districts in 34 communities and testing sites at Welcome Centers and Michigan airports are in the works for returning travelers, as well.

Bill Expands Those Considered Mental Health Pros – And Who Can Restrain Patients

Psychiatric physician assistant Ken Gorney spent the last decade providing treatment to “literally thousands of patients,” providing assessments, diagnoses and treatments as a mental health professional.

However, under Michigan’s Mental Health Code, he wasn’t actually a “mental health professional.”

Having served at McLaren Health Care and Sparrow Health System, it was nearly five years ago when Gorney was told by state surveyors that nurse practitioners, PAs and nurse specialists were not recognized under code — something that SB 0191 from Sen. Curt VanderWall (R-Ludington) is intended to modernize, despite an earlier version failing in the last legislative session.

“We should be able to provide the same level of care and treatment that we provide in the public health setting in the mental health setting,” Gorney said. “The ultimate goal of this bill is to provide treatment and care for patients, not to protect the financial interests of independent practitioners in the realm of psychiatry, because I think that’s largely what’s driven by the obstacles opposing this bill.”

Under SB 0191, a PA, nurse specialist and nurse practitioner would be able to:
– Administer the independent examination of a person who is at least 18 years old and whose outpatient or treatment facility care has been ordered by a court. They could also provide the patient with an in-person testimony when admission into a community mental health services program (CMHSP) has been ordered.

– Authorize a resident to be restrained until their examination, which they would also be permitted to conduct.

– Perform the examination needed to produce a clinical certificate to hospitalize an individual.

“Over the past year, the COVID-19 pandemic has highlighted the need for improved and enhanced mental health access for Michigan residents,” said Anne Kreft of the American Nurses Association’s Michigan Chapter at the March 25 Senate Health and Policy and Human Services Committee meeting.
Kreft serves as a psychiatric mental health charge nurse at the Munson Medical Center in Traverse City. She said updating the statute would “reflect the real-life reality” that those in the aforementioned professions do serve patients in every type of psychiatric medicine, behavioral health and mental health setting in every region of Michigan.

“These trained professionals enable people to connect with the care they so desperately need, aligning the mental health code with the public health code eliminates confusion and allows a network of providers that are appropriately trained to deliver critical care for patients in need,” she said.

The bill was faced with opposition from the Michigan Psychiatric Society, Disability Rights Michigan, the Autism Alliance of Michigan and the executive committee for the Michigan Council of Child and Adolescent Psychiatry.

At the meeting, Dr. Duane DiFranco of the MPS expressed his concerns with seclusion and restraint over patients and how SB 0191 will expand the roster of who can call for them.

He reminded the committee that these actions “are dangerous interventions,” where a person’s civil liberties are temporarily removed and why the outlines in the Mental Health Code exist.

“The easy thing to do when you’re making a clinical decision about seclusion, restraint or civil commitment is to commit or restrain or seclude — the importance of training and experience is knowing when and how to avoid those things. Less training means more restraint,” DiFranco said.

Colleen Allen, president of the Autism Alliance of Michigan, said her organization is “just downright opposed to any measure that would broaden the scope or ability to implement or use seclusion and restraint.”

“We recognize the workforce shortage,” Allen said. “If amendments, strong amendments that professional associations can come forward with that would assure us of the safety of our population, we certainly would want to talk about those.”

Advocates Call For Unleashing Of $54M For Mental Health Services

Special interest groups including schools and needy families are anxiously awaiting the federal and state COVID dollars totaling $54 million for mental health services that they say are badly needed right now.

“The crisis that our students have gone through over the past year does not end with a vaccine. It does not end with a classroom getting reopened,” said Robert McCann from the K-12 Alliance of Michigan.

His members are seeing the mental health problems firsthand as students return to in-class learning and when they get there, McCann said teachers are aware that, “many of these students we have found have not had a stable home life over the past 12 months and that affects them far more than just a learning loss.”

Which is why he argues lawmakers need to allocate these dollars so educators can assess the needs of each student.

“As we get them back in the classroom, if we’re not asking them how they are doing and what individual support they need to be successful, we are only setting them up for further failures,” he said.

As for the continuing back and forth between the administration and legislative Republicans, McCann said, “it’s tremendously frustrating. That’s not a subject a superintendent, a teacher or student that cares about these power battles.”

Ditto from former Sen. Gilda Jacobs who now advocates for needy families.

“I’m just so distressed by this,” she said, suggesting that the two sides must find another way to handle this dispute.

She echoed McCann saying the state assistance “is so needed right now.”

Jacobs said, “I know you’ve heard the stories about the increase in child abuse, in domestic abuse, suicides and addiction. This pandemic has hit so many people. It is in every corner of the state.”

The president and CEO of the Michigan League for Public Policy does see a silver lining in that, “this pandemic has really shed light on areas that we have underinvested in and not invested in at all. We are seeing the progress that needs to be strengthened permanently. So it really is an opportunity.”

Senate Wants $1.25M To Investigate Nursing Homes; Hornberger Wants $5M

County prosecutors interested in investigating possible criminal charges related to nursing home deaths from COVID-19 could receive up to $250,000 grants from a pool of $1.25 million under a spending bill that passed the Senate March 25.

A revamped version of SB 0027 sponsored by Sen. Lana Theis (R-Brighton Twp.) has one spending item within it and that is the grants to the prosecutors.

“This bill provides resources to county prosecutors to do what our Attorney General has refused to do and investigate the deaths of thousands of mothers, fathers, grandmothers and grandfathers on behalf of those who are lost,” Theis said.

The bill passed on a strict party-line 20-15 vote.

Later in the day, House Speaker Pro Tem Pamela Hornbeger (R-Chesterfield Twp.) introduced a similar bill, HB 4589, that set aside $5 million to county prosecutors in the form of grants, using a process that was used in the Flint water crisis.

She noted the Prosecuting Attorneys Coordinating Council allows access to grant money for local prosecutors.

The money comes amid Macomb County Prosecutor Pete Lucido’s look into whether state policies in allowing COVID-19 patients to return to their nursing homes before they were fully recovered was some act of criminal negligence. Attorney General Dana Nessel has declined to look into the matter.

Sen. Curtis Hertel Jr. (D-East Lansing) and fellow Democrats decried the legislation as being purely political given there was top-down state mandate that nursing homes must accept COVID-19-positive patients. They argued a recent MLive report showed there is no smoking gun on the Governor’s handling of coronavirus in nursing homes and deaths.

“So, I would suggest, again, if you’re going to tell the truth, you should at least try to figure out what the truth is,” he said. “Those that are in the nursing home industry have clearly stated that no nursing homes were ever forced to take COVID patients.

“It may be more convenient if it was true. It may be politically convenient if it was true. And it may make a nice news story if it was true. Unfortunately, in order for things to be true, they actually have to have evidence to be true. And paying someone $250,000 is not going to prove it true either.”

The Senate Democrats, led by Sen. Winnie Brinks (D-East Grand Rapids), attempted to make the bill a $2.36 million COVID-19 relief supplemental with money going to impacted businesses and a property tax relief program, among other things, but it was rejected.

Possible Third Surge Of COVID-19 Has Hospitals Sweating

Hospitals warned today that COVID-19 hospitalizations are increasing at an “alarming rate,” as the state reported another 4,000-plus confirmed cases for the second time in three days.

From March 1 to March 23, hospitalizations increased by 633 percent for adults ages 30-39 and by 800 percent for adults ages 40-49, according to data shared by the Michigan Health and Hospital Association.

The MHA said hospitalization growth rates declined as the vaccination rates per age group increased. Hospitalizations increased by 37% for adults 80 or older, of which 44% of the population are fully vaccinated in the state.

“While much of our healthcare workforce is vaccinated, caring for a third surge of COVID-19 patients is mentally and physically draining for all front-line caregivers,” said MHA CEO Brian Peters in a statement. “Failing to follow proven preventive measures is not only dangerous to our health but hurts our economy and delays when in-person activities such as returning to work can occur with minimal restrictions.”

When asked if the recent uptick in COVID-19 cases and other data points are indicating a third wave of COVID-19 has hit Michigan, MHA spokesperson John Karasinski said, “this could be the start of another surge, but we’re hopeful these trends can be flattened quickly by people stepping up their preventive measures and more vaccines being administered each day.”

In the midst of the November COVID-19 spike, the hospitals spoke up about the record setting pace of hospitalizations at the time.

Just days after the hospitals announced that in November, the Michigan Department of Health and Human Services instituted the pause that closed in-person dining and tightened other COVID-19 restrictions.

Asked if this is the beginning of a third wave, DHHS spokesperson Lynn Suftin said in late March “the presence of more infectious variants, such as the B 1.1.7 variant, threatens our progress in control of the epidemic and MDHHS will be monitoring data closely.”

She added that the state’s “goal is to reengage while reducing public health risk, which is why we move slowly to maintain progress and momentum with thoughtful public health measures.”

Meanwhile, the number of confirmed COVID-19 cases reported today cracked 4,000 again, the second time in three days of reporting.

The 4,454 cases added today bring the statewide total to 637,645 over the course of the pandemic. Another 16 deaths reported today makes it 15,935 total.

The overall positivity rate for COVID-19 tests is more than double what it was a month ago, going from the 3.5 percent seven-day average back on Feb. 19 to the 8.1 percent on March 19, the date of the most available stats at the MI Safe Start Map.

House Swallows Speaker’s Lower Drug Price Bills

All 15 of House Speaker Jason Wentworth’s (R-Farwell) health reform bills moved through the House—some easier than others—March 24 in the first major legislative victory for the Republican leader.

The populist package heralded as a state legislative strategy to lower the cost of prescription drugs passed with Democrats opposing a few bills and conservative Republicans opposing most of the others. The bills also advanced without the unified support of any special interest group in particular.

“This is leading the nation,” Wentworth said after the vote. “This package leads the country in this type of reform. I think that is going to be shown over the next several weeks as this package gets reviewed by national groups and think tanks across the country.”

All of the bills withstood the criticism of several interest groups that tried to pick the package apart and a late effort by at least one conservative outfit, Scott Hagerstrom’s Michigan Prosperity Project, which called the package in a late push “Obamacare 2.0.”

Wentworth called the accusation “laughable” and there were “just a lot of falsehoods” in the statement issued by that group over the weekend.

“The fact is, this is what people are looking for their government to do. Find bipartisan solutions. Make it a process that works for the people, something that works for our constituents,” Wentworth said.

Working side-by-side with Wentworth on the bills was Rep. Abdullah Hammoud (D-Dearborn), who told the House chamber how a goal of his for the first two decades of his life was to acquire an insurance card, to “get that Cross and Shield.”

When he final achieved one and realized all of the co-pays involved, he became fairly disenchanted with the coverage.

“Madam Speaker, what is the point of having an insurance card in your wallet that you cannot afford to use?” Hammoud said. “Somewhere along the road, the Shield started prioritizing sustainability of profits over sustainability of our residents. Today that changes.”

Support and opposition for the various bills was all over the map.

The health plans supported the expansion of out-of-state telehealth services, but opposed restrictions on how drug rebates or discounts are given.

Business groups bristled at $50 co-pay caps on insulin and $150 co-pays on oral chemotherapy because they fear their member will end up shouldering the shifted costs. However, the National Federation of Independent Businesses liked new regulations on pharmacy benefits managers.

Even business groups were not unified in their support or opposition to some of the bills. The Michigan Chamber of Commerce and the Michigan Manufacturers Association didn’t like the pharmacy benefits managers bills that the NFIB supported.

The Grand Rapids Chamber supported a drug transparency bill, while the MMA opposed it.

On the black-and-white tiles, various groups were all over the board on bills that would expand the powers of nurse anesthetists. The hospitals and nurses unions were all about HB 4359, while the Michigan State Medical Society and the Michigan Association for Justice was against it.

The closest vote was on HB 4355, which expanded the public’s ability to use telehealth from out-of-state providers, which Democrats predominately voted against. The bill was at 54 votes for about a half hour until Rep. Greg VanWoerkom (R-Norton Shores) and Rep. Shri Thanedar (D-Detroit) went green to give it 56 votes.

Some of the bills are new issues, such as Rep. Julie Calley’s (R-Portland) HB 4348. The bill sets up new licensing for pharmacy benefit managers, which she called middle men who were engaged in an “pay to play” system that ultimately hurt the consumer, she said.

Not only do some consumers pay more, customers may ultimately not get the drug that would work best for them because the manufacturer didn’t provide the best rebate.

“This is nothing short of egregious,” Calley said.

Another new concept is a ban on so-called “accumulator” programs that block rebates or coupons from nonprofits or drug manufacturers from counting against a patient’s copays or deductibles.

With many finding health insurance, medical care and prescription drugs out of reach due to high excessive out-of-pocket costs, Rep. Laurie Pohutsky (D-Livonia) said “anything we can do to ease the burden is not only the right thing to do, it is our moral and professional obligation as servants of the state of Michigan.”

Rep. Mark Tisdel (R-Rochester Hills) said he understands HB 4346, which caps co-pays for insulin at $50 per month may shift costs, but it would shift costs to “larger, better organized and politically represented health insurance companies and employers. And there is plenty of pain to shift.”

The bills face an uncertain future in the state Senate, where they, at the very least, create a huge bargaining chip the Speaker can use later in the legislative session.

NFIB assistant state director Amanda Fisher said the bills are certainly “well-intentioned,” but “health policy at the state level is tough because there’s only so much the state can do.”

Likewise, Blue Cross Blue Shield of Michigan said that while the insurance company supports policy changes that address the high cost of prescription drugs, they’re concerned about the unintended consequences of the bills.

“This will result in cost shifts to employers, increased administrative burdens on patients, higher prescription drug costs and higher health care costs for everyone,” said Mark Cook, BCBSM’s vice president of government and regulatory affairs.

 Senate Allows Hertel Appointment As DHHS Director To Go Through

The full Senate allowed the appointment of Michigan Department of Health and Human Services Director Elizabeth Hertel to go through, a move led by Senate Majority Leader Mike Shirkey (R-Clarklake) over a split Republican caucus.

With today being the deadline by which to reject her nomination, if that was the intention, the Senate instead made a motion to advice and consent to the appointment. With 19 votes needed for final passage, the final vote was 18-16, one vote short.

All of the chamber’s Democrats who voted were in support. They joined four Republicans—Sen. Ken Horn (R-Frankenmuth), Sen. Wayne Schmidt (R-Traverse City), Shirkey and Sen. Jim Stamas (R-Midland), all second-term members.

Hertel’s husband, Sen. Curtis Hertel Jr. (D-East Lansing) abstained from the vote due to a conflict of interest and Sen. Mallory McMorrow (D-Troy) is on maternity leave.

The governor’s team responded that the Governor is “excited” to have Hertel as the DHHS director after a career of protecting “Michiganders’ public health.”

“Her leadership will be critical as we continue tackling the public health challenges facing our state,” reads a statement from Press Secretary Bobby Leddy. “With more than 3.5 million safe and effective vaccines having been administered to date, there is light at the end of the tunnel, but we must continue doing the right things to eliminate COVID-19 and get back to normal as quickly as possible.”

Hertel said the chance to lead DHHS is “the honor of a lifetime.” She said she appreciated the comments from legislators on both sides of the aisle and she plans to work with them, public health experts and stakeholders in trying to end the pandemic.

“I will remain strongly committed to protecting the health, safety and well-being of Michigan residents,” she said. “The decisions we make have real and significant impacts in the lives of our friends, neighbors and family.”

Shirkey declined to answer questions today after session, but did issue the following statement, “My vote in favor of Elizabeth Hertel’s appointment does not reflect agreement with her decisions as deputy director and now as director of MDHHS, but rather my belief that her background and expertise makes her qualified for the job.

“To her credit, in the short time since her appointment, I have had more conversations with Elizabeth than I did over two years with her predecessor. That communication with the Legislature must continue if are to repair the damage done by the incompetence of the previous leadership.”

The motion to approve the Hertel appointment gave Senate Republican members unlimited time to give their “no vote” explanations.

Conservative Republicans, led by Sen. Jim Runestad (R-White Lake), argued Hertel was too much of a Whitmer apologist. They bristled at Hertel’s unwillingness to critically analyze the Whitmer administration’s initial COVID-19 restrictions, in particular the decision to put COVID-19 patients into nursing homes.

The Whitmer administration spent $22 million on a pair of lightly used field hospitals as opposed to housing recovering patients at these locations, they claim. They also raise questions about the transparency of DHHS, particularly when it comes to releasing data on nursing home deaths due to COVID-19.

“I will not vote to confirm a director for our state’s health department who cannot admit that mistakes were made,” said Sen. Ruth Johnson (R-Holly). “Nor will I vote to confirm a health director who continues to obscure the data used by the department to make important decisions.”

Republicans also are agitated that Whitmer continues to not invite Republican lawmakers to the table when it comes to the degree to which COVID-19 restrictions are imposed or the ability for businesses to open up. Rejecting gubernatorial appointments is the only tool they have to exert any power over the process, which they’ve done in bouncing several university and lower-tier appointments this year.

Runestad argued that DHHS’ responses to COVID-19 has been “chaotic” and nothing is going to change at the departments under Hertel.

However, Hertel has a long history in Lansing with enough pre-established relationships that would make her rejection—while politically desirable—functionally difficult.

For example, the Senate has a new chair of the House DHHS Appropriations Subcommittee, whose staff has worked well in the past with the former Trinity Health official, Public Sector Consultants analyst and House Republican policy staffer.

The realization is that Whitmer isn’t going to appoint a DHHS director who isn’t on the same page as her. It’s best to clear the way for someone they feel comfortable working with as opposed to someone who came across as a cold fish, like former Director Robert Gordon.

Today marked the last day under a 1964 Attorney General Frank Kelley decision that the Senate could act on the Whitmer appointment, however Republicans could push the matter in court if it were inspired.

The Constitution gives the Senate “60 session days” to reject a gubernatorial appointment. Kelley interpreted that as 60 consecutive days when the Senate is in session, which would include Saturdays and Sundays. The Republican majority could argue in court it means 60 actual session days, which would, theoretically, stretch the Senate’s advice and consent power over Hertel into June.

The unsuccessful vote to advice and consent to the Hertel appointment doesn’t necessarily take that option off the table, but Senate Republican leadership is treating the Hertel appointment as settled and is moving on to other subjects, a source told MIRS.

Sen. Hertel said skipping the vote was ‘the hardest vote I will skip,” and not because she is his wife, but because she is so qualified it hurt him to have to sit it out due to the obvious personal conflict.

“She is by far the most qualified person that could be nominated,” he said, noting the care she puts into the job in a non-partisan way.