Friday, October 16, 2020

Dying Inside -- Why 4,998 died in U.S. jails without getting their day in court

I have not read this link closely but I'm keeping this copy (images deleted) for future reference because it is important.

~~~


By PETER EISLER, LINDA SO, JASON SZEP, GRANT SMITH and NED PARKER

Filed Oct. 16, 2020, 11 a.m. GMT


Harvey Hill wouldn’t leave John Finnegan’s front yard. He stood in the pouring rain, laughing at the sky, alarming his former boss' wife. Finnegan dialed 911.

“He needs a mental evaluation,” the landscaper recalls telling the arriving officer. Instead, Hill was charged with trespassing and jailed on suspicion of a misdemeanor offense that could bring a $500 fine.
TURNAROUND, TRAGEDY: Harvey Hill’s life was on track, his family said, before his trespassing arrest. REUTERS/Hill family handout

It was a death sentence.

The next day, May 6, 2018, Hill’s condition worsened. He flew into a rage at the Madison County Detention Center in Canton, Mississippi, throwing a checkerboard and striking a guard with a lunch tray.

Three guards tackled the 36-year-old, pepper sprayed him and kicked him repeatedly in the head. After handcuffing him, two guards slammed Hill into a concrete wall, previously unpublished jail surveillance video shows. They led him to a shower, away from the cameras, and beat him again, still handcuffed, a state investigation found. The guards said Hill was combative, exhibiting surprising strength that required force.

Video showed Hill writhing in pain in the infirmary, where he was assessed by a licensed practical nurse but not given medication. Mississippi law dictates that a doctor or higher credentialed nurse make decisions on medical interventions. But Hill was sent straight to an isolation cell, where a guard pinned him to the floor, removed his handcuffs, and left him lying on the cement. Hill crawled to the toilet. Then he stopped moving.

No one checked him for 46 minutes. When they did, he didn’t have a pulse. Within hours, he was dead. And he had a lot of company.

Hill’s is one of 7,571 inmate deaths Reuters documented in an unprecedented examination of mortality in more than 500 U.S. jails from 2008 to 2019. Death rates have soared in those lockups, rising 35% over the decade ending last year. Casualties like Hill are typical: held on minor charges and dying without ever getting their day in court. At least two-thirds of the dead inmates identified by Reuters, 4,998 people, were never convicted of the charges on which they were being held.

Unlike state and federal prisons, which hold people convicted of serious crimes, jails are locally run lockups meant to detain people awaiting arraignment or trial, or those serving short sentences. The toll of jail inmates who die without a case resolution subverts a fundamental tenet of the U.S. criminal justice system: innocent until proven guilty.

“A lot of people are dying and they've never been sentenced, and that's obviously a huge problem,” said Nils Melzer, the United Nations’ special rapporteur on torture and other inhuman punishment, after reviewing the Reuters findings. “You have to provide due process in all of these cases, you have to provide humane detention conditions in all of these cases and you have to provide medical care in all of these cases.”

The U.S. Constitution grants inmates core rights, but those provisions are hard to enforce. The Fourteenth Amendment guarantees fair treatment to pre-trial detainees, but “fair” is open to interpretation by judges and juries. The U.S. Supreme Court has ruled that the Eighth Amendment’s ban on cruel punishment forbids “deliberate indifference to serious medical needs of prisoners,” but proving deliberate negligence is difficult. The Sixth Amendment assures speedy trials, but does not define speedy.

The Reuters analysis revealed a confluence of factors that can turn short jail stays into death sentences. Many jails are not subject to any enforceable standards for their operation or the healthcare they provide. They typically get little if any oversight. And bail requirements trap poorer inmates in pre-trial detention for long periods. Meanwhile, inmate populations have grown sicker, more damaged by mental illness and plagued by addictions.

The 7,571 deaths identified by Reuters reflect those stresses. Most succumbed to illness, sometimes wanting for quality healthcare. More than 2,000 took their own lives amid mental breakdowns, including some 1,500 awaiting trial or indictment. A growing number – more than 1 in 10 last year – died from the acute effects of drugs and alcohol. Nearly 300 died after languishing behind bars, unconvicted, for a year or more.

As with much of the U.S. criminal justice system, the toll behind bars falls disproportionately on Black Americans, such as Hill. White inmates accounted for roughly half the fatalities. African Americans accounted for at least 28%, more than twice their share of the U.S. population, a disparity on par with the high incarceration rate of Blacks. Reuters was not able to identify the race of 9% of inmates who died.

Jail deaths typically draw attention locally but escape scrutiny from outside authorities, a gap in oversight that points to a national problem: America’s system for counting and monitoring jail deaths is broken.

A broken system of federal oversight

America’s 3,000-plus jails are typically run by county sheriffs or local police. They often are under-equipped and understaffed, starved for funds by local officials who see them as budgetary burdens. A rising share have contracted their healthcare to private companies.

Yet there are no enforceable national standards to ensure jails meet constitutional requirements for inmate health and safety. Only 28 states have adopted their own standards to fill the gap. And much of the oversight that does exist is limited by a curtain of secrecy.

The Justice Department’s Bureau of Justice Statistics has collected inmate mortality data for two decades – but statistics for individual jails are withheld from the public, government officials and oversight agencies under a 1984 law limiting the release of BJS data. Agency officials say that discretion is critical because it encourages sheriffs and police to report their deaths data each year.

The secrecy has a cost: Local policy makers can’t learn if their jails’ death rates are higher than those in similar communities. Groups that advocate for inmates’ rights can’t get jail-by-jail mortality data to support court cases. The Justice Department’s own lawyers, charged with taking legal action when corrections facilities violate constitutional standards, can’t readily identify jails where high death counts warrant federal investigation.

“If there’s a high death rate, that means there’s a problem,” said Julie Abbate, former deputy chief of the Justice Department’s Special Litigation Section, which enforces civil rights in jails. Publicizing those rates “would make it a lot harder to hide a bad jail.”

The Justice Department does issue broad statistical reports on statewide or national trends. But even those fatality numbers don’t always tell the full story.

Some jails fail to inform BJS of deaths. Some report them inaccurately, listing homicides or suicides as accidents or illnesses, Reuters found. Justice Department consultant Steve Martin, who has inspected more than 500 U.S. prisons and jails, said that in all the cases he's investigated, he recalls only one homicide being reported accurately. The others were categorized as “medical, respiratory failure, or whatever,” he said.

Other jails find other ways to keep deaths off the books, such as “releasing” inmates who have been hospitalized in grave condition, perhaps from a suicide attempt or a medical crisis, so they’re not on the jail’s roster when they die. Sheriffs sometimes characterize these as “compassionate releases” that allow inmates’ families a chance to spend their final hours together without law enforcement supervision.

In all, Reuters identified at least 59 cases across 39 jails in which inmate deaths were not reported to government agencies or included in tallies provided to the news organization.

The Justice Department has grown more secretive about the fatality data under the Trump administration. While BJS never has released jail-by-jail mortality figures, it traditionally has published aggregated statistics every two years or so. The 2016 report wasn't issued until this year.

And, a Justice spokesman said, there are “no plans” to issue any future reports containing even aggregated data on inmate deaths in jails or prisons.

The report delays are “an outrage,” said Representative Bobby Scott, a Virginia Democrat who co-authored the original reporting law in 2000 with a Republican colleague. Scott said secrecy was never the goal. He co-authored a 2014 update, which restricts federal grant money when jails don’t report deaths and shifts data collection to a different Justice Department agency that would not be restricted from releasing jail-by-jail data. The updated law has yet to be implemented.

“The whole point,” Scott said, “is we suspect a lot of the deaths are preventable with certain protocols – better suicide protocols, better healthcare, better guard-to-prisoner ratios. You’ve got to have information at the jail level. You have no way of really targeting corrective action if you don’t.”

Because the government won’t release jail-by-jail death data, Reuters compiled its own. The news organization tracked jail deaths over the dozen years from 2008 to 2019 to create the largest such database outside of the Justice Department. Reporters filed more than 1,500 records requests to obtain information about deaths in 523 U.S. jails – every jail with an average population of 750 or more inmates, and the 10 largest jails or jail systems in nearly every state. Together, those jails hold an average of some 450,000 inmates a day, or about three out of every five nationwide.

Reuters is making the full data it gathered available to the public.

One finding: Since the last Justice Department report, for 2016, the death rate in big jails has continued to climb, leaving it up 8% in 2019, the highest point in the 12-year period of 2008-2019 examined by Reuters. In that time, the suicide rate declined as many facilities launched suicide awareness and response initiatives. But the death rate from drug and alcohol overdoses rose about 72% amid the opioid epidemic.

The data also reveals scores of big jails with high death tolls, including two dozen with death rates double the national average.

Such data “would have actually been very helpful for enforcement purposes,” said Jonathan Smith, who ran the Justice Department’s Special Litigation Section from 2010 to 2015.

Rare scrutiny, reform

Detailed insight into jail deaths can save lives.

In 2016, the Justice Department began investigating the Hampton Roads Regional Jail in Portsmouth, Virginia, after state Attorney General Mark Herring and local civil rights groups called for a probe following several inmate deaths. Reuters found the jail, which serves five jurisdictions, averaged 3.5 deaths per thousand inmates over the years 2009 to 2019, more than double the national average of 1.5 deaths.

In December 2018, the Justice Department said the 900-bed jail violated inmates’ rights by failing to provide adequate medical and mental healthcare. The regional authority that manages the jail agreed to a “consent decree,” enforced by a federal judge, to ensure improved treatment of prisoners.

Inmate deaths dropped after the agreement, which required increased staffing, better training and enhanced medical services. The jail reported two fatalities in 2019 and one through this May, down from an average of five a year in the prior four years.

That was one of the Justice Department’s last jail investigations. From 2008 to 2018, the department opened 19 investigations into jails, three during President Trump’s tenure.

Yet since 2018, it hasn’t opened any. A memo circulated in November 2018 by then-Attorney General Jeff Sessions put hurdles in the way of entering consent decrees for overhauling jails. In a telephone 
interview, Sessions told Reuters the policy he set forth adhered to Supreme Court standards on when consent decrees could be entered, allowing them when “appropriate” and “justified.”

In the absence of federal oversight, states have a patchwork of guidelines.

Seventeen states have no rules or oversight mechanisms for local jails, according to Reuters research and a pending study by Michele Deitch, a corrections specialist at the Lyndon B. Johnson School of Public Affairs at the University of Texas. In five other low-population states, all detention facilities are run by state corrections agencies. The other 28 have some form of standards, such as assessing inmates’ health on arrival or checking on suicidal inmates at prescribed intervals. Yet those standards often are minimal, and in at least six of the states, the agencies that write them lack enforcement power or the authority to refer substandard jails for investigation.

Deitch said these gaps make comprehensive nationwide statistics all the more important. “You can’t have good policy without good data,” she said. “Data tells us what is going right and what’s going wrong.”

The Fossil

Without jail-by-jail mortality data, even jails with extraordinary death rates can escape official intervention for years, and local officials can remain blind to the seriousness of problems their facilities face. One example is the Marion County Jail in Indiana, a decrepit 65-year-old facility nicknamed “The Fossil” within the sheriff’s department.

Overfilled and understaffed, the Marion County jail had at least 45 deaths from 2009-2019. Yet local officials rejected pleas from two consecutive sheriffs for additional funding to bolster staffing and build a new facility.

Reuters found that the jail is among the two dozen with an average death rate, 3.5 deaths per 1,000 inmates, at least double the national average from 2009 to 2019. And its record was troubling on one of the most challenging problems plaguing jails: suicide, which accounted for more than a quarter of all U.S. jail deaths.

Thomas Shane Miles, a married father of two, struggled for years with mental illness and opioid addiction when he was arrested in 2016 on a misdemeanor drug possession warrant. On his second day in jail, he flung himself down a stairway and swallowed the contents of a chemical ice pack.

Put on suicide watch, Miles was given a “suicide smock” – a heavy hospital-style gown closed with Velcro – and placed in a monitored cell. The jail’s policies, as well as American Bar Association guidelines, dictate that suicidal inmates be monitored continuously.

On Day 6, Miles was given a jail uniform for a hearing and escorted down an underground hallway to a holding cell below the adjacent court building – a cell with no video monitor or clear sightlines for deputies. Left alone, he tore a strip of cloth from the collar, looped it over a door hinge and hung himself. He was found unconscious 30 minutes after entering the cell. An internal inquiry said the supervising officer logged his rounds after the fact, leaving it unclear when Miles was checked.

In a wrongful death suit that settled this September, Miles’ family argued that despite being identified as a suicide risk, he was given the means and opportunity to kill himself. The sheriff’s office denied misconduct and said it admitted no wrongdoing in the settlement; details were not disclosed.

Miles’ suicide was the jail's seventh in just under 15 months. The Fossil’s suicide rate ranked it among the top 20 jails in the Reuters study.

In 2016, the sheriff called the suicide problem an “epidemic,” but county officials denied requests for more funding. While the county knew it had a suicide problem, there was no way to know how it compared. Like all other officials, Marion County’s leaders had no access to the Justice Department figures.

The sheriff’s jail-management mission often “came in second” in a budget system that pits it against the Indianapolis police department’s law enforcement duties, said Frank Mascari, who sits on the City-County Council. “We knew there were some deaths” at the jail, he said, “but we didn’t have the statistics” to know the rates were extraordinary.

From 2015 to 2017, the sheriff’s budget grew just over 1% a year, audit figures show. The inmate population rose 12% in that time, due to a rise in arrests and to state legislation dictating that some low-level felons serve their sentences in county jails, not state prisons.

The sheriff launched suicide-prevention efforts, hired social workers and trained deputies in spotting suicide warnings. From 2017 to 2019, the number of suicides dropped to two a year, but staffing remained critically low as deputies routinely left for better paying jail jobs in nearby suburbs.

Jail deaths remained stubbornly high despite the decline in suicides, reaching six last year, the heaviest toll in more than a decade, driven in part by drug and alcohol overdoses. Still, there has been no state or federal intervention.

In July 2018, Kyra Warner, 30, went quiet about 90 minutes after arriving at the jail. As her limbs twitched, cellmates called for help, telling nurses and deputies that Warner said she had been using methamphetamine and anti-anxiety drug Xanax.

Jail video shows Warner unable to walk on her own as deputies moved her to a monitored isolation cell, where they left her on the floor, still twitching. She lay unresponsive as they checked her periodically over two hours – until medical staff found no pulse. She died of an accidental overdose.

“The officers that are watching aren’t medically trained,” said Rich Waples, a lawyer handling the family’s ongoing wrongful death lawsuit against the sheriff and Wellpath, the company providing the jail’s healthcare. “If she’d gotten prompt care, they could have reversed the effects of those drugs.”

Jail officials denied wrongdoing and noted in their response to the suit that deputies checked on Warner numerous times, but added they are not medical professionals. Wellpath, also contesting the ongoing suit, denied any misconduct.

“We’re not built to be the largest mental health hospital in the state,” said Colonel James Martin, who oversees the jail. “We’re not built to be the largest detox facility in the state.” Yet the jail has “more detox beds than any single hospital in the state.”

The jail’s shortcomings have been documented, including a county-commissioned review in 2016 that found the Fossil “antiquated,” with inadequate staffing and design flaws that severely hamper inmate monitoring. In 2018, after another independent study highlighted the jail’s challenges, the county approved a new $580 million criminal justice complex, with dedicated facilities to treat mental illness and substance abuse. In 2022, the Fossil will be history.

‘JUST WRONG

Another flaw in the U.S. system for monitoring jail fatalities is misleading disclosure. The John E. Polk Correctional Facility in Florida's Seminole County reported one death to the Justice Department in 2019. But at least one other death at the jail was not reported in its official filings.

On June 2, 2019, Thomas Harry Brill, 56, was found hanging by a bed sheet in his cell. Staff tried but failed to resuscitate him, the jail said. He was pronounced dead at a nearby hospital. Sheriff’s spokeswoman Kim Cannaday said he “was released out of our custody” before he died. “Therefore, it would not technically be considered an in-custody death.”

Brill’s sister, Tracy, was shocked to learn his death was excluded from the jail’s official count. “They’re trying to avoid responsibility,” she told Reuters. “They’re playing with the numbers. That’s just wrong.”

Brill graduated from Eastern Michigan University with a mathematics degree and lived on a sailboat for years, she said. He had been wrestling with mental illness when he flew from his home in San Diego to look at a boat in Florida. Out of money, he was found in a stolen car and arrested, but couldn’t afford bail. He died unconvicted of the charge. “He needed $500 to get out,” she said. “It was an awful, ridiculous waste that he died.”

A death in Mississippi

The Reuters death database also points to another benefit of collecting and publishing jail mortality rates: It can identify an unusual number of fatalities at jails that typically have few. One is Mississippi’s Madison County Detention Center, where Harvey Hill died after being beaten by guards.

The jail had occasional deaths, and in several years reported none. Yet in 2018, it had two deaths, including an inmate who died of complications from an ectopic pregnancy. Few other jails its size had multiple deaths that year.

Hill grew up in the poorest county in the poorest state in America. West, his town of 185 people, is intersected by a four-lane highway in Mississippi’s rural Holmes County. He did landscaping work an hour’s drive south in Canton, a city of 13,000 in the state’s wealthiest county, where 19th Century antebellum shophouses packed with antiques line a postcard-perfect downtown square.

When he was 18, Hill was arrested on charges of sexual battery and robbery. He pleaded guilty and served 14 years in prison. Friends and family say he began piecing together his life after his 2015 release, taking landscaping jobs with business owner Finnegan. “He was an incredible worker,” said Finnegan.

Through the winter of 2017 into the spring, Hill showed signs of mental illness, displayed flashes of paranoia and complained of insomnia, said Finnegan. After he let him go in 2018, Hill started showing up at his home, claiming his old boss owed him millions of dollars. “Harvey, if I had taken your millions, I wouldn’t be landscaping. I would be on an island,” Finnegan recounts telling him.

Hill kept returning. In May 2018, Finnegan called the Madison Police Department. If he wanted Hill removed, he had to press charges, Finnegan said he was told, so he did. “That’s not something I really wanted to do,” he said. “Harvey needed to be in a mental hospital.”

At the station, Finnegan told the officer he’d drop the charges and take Hill to a mental health facility if they could find a room. Instead Hill was booked into Madison County’s jail that Friday morning. “I’ll pick you up on Monday,” said Finnegan. “And we’ll get you some help.”

The Madison Police Department said there were “no remarkable or extraordinary events related to his arrest.” Mississippi has no standards or oversight for jails.

In their response to a family lawsuit, the guards said their actions were proper under jail policy. Michael Wolf, an attorney for one of the guards, James Ingram, told Reuters that Hill bit and then tried to head butt an officer, “and continued to resist and exhibited unusual strength. The control techniques were consistent with the County use of force continuum.” The other guard named in litigation, James Buford, declined to comment.

The family believes the force was unjustified. “Harvey Hill was in handcuffs and beaten to death,” said Derek Sells, a lawyer representing the family. “Someone needs to be held responsible.”

Hill’s death was one of four Reuters identified at the jail over the 12-year period. After he died, the jail filled out a form for the BJS with Hill’s name and details including his race, age and charges. The box for “homicide” was left unchecked. Two years later, no “cause of death” has been sent to the BJS, the jail said, citing an ongoing investigation by the Mississippi Bureau of Investigation. No one has been charged.

An autopsy ruled Hill’s death a homicide, however. The report showed that abrasions speckled his head and chest. Severe internal bleeding swelled his neck. His liver had been lacerated.

The state medical examiner, citing a backlog, didn’t release the findings to the family until this June, 25 months after he died and 13 months after the statute of limitations had expired for litigation involving assault. The family filed its ongoing lawsuit last February, before receiving the autopsy.

Told by Reuters of the autopsy’s grim findings, Finnegan bent forward and choked back tears. “God Almighty,” he said, dragging a hand over his face. “Harvey was a friend.”

~~~~~~~~~~~~~~~~

How Reuters tracked and analyzed deaths in America’s largest jails
By GRANT SMITH and PETER EISLER

The Reuters examination of deaths in U.S. local jails represents the largest collection and publication of inmate mortality data undertaken outside the federal government.

The news organization filed more than 1,500 public records requests to collect data on inmate populations and deaths from more than 500 local jails. That universe includes the 10 largest jails in each state, as well as any jail in the country with an average daily population of 750 or more inmates.

In all, the Reuters data captures about 60% of the total inmate population in the nation’s 3,000-plus jails. Similarly, Reuters data accounts for about 60% of all inmate deaths nationwide, based on the latest national data collected by the U.S. Bureau of Justice Statistics. BJS issues national-level and state-level data on jail deaths, but no statistics for individual jails. The Reuters investigation is the first to provide individual jail death data on a national scale.

Reuters calculated annual death rates at more than 500 jails by dividing the total number of deaths in a given year by the average daily population in the same year – the same formula used by BJS and other experts in criminal justice statistics.

4,998
Number of inmates in jails surveyed by Reuters who died 
without getting their day in court


States and local law enforcement agencies have varying definitions for what constitutes a jail death. Reuters counted all deaths that occurred in a jail, as well as deaths of inmates who were hospitalized for injuries or conditions incurred at the jail. When inmates are in life-threatening condition, some jails release them and do not count their subsequent death as an inmate fatality. Reuters, like many jurisdictions across the country, included those cases in its tally of jail deaths.

Reuters received responses from more than 95% of the jurisdictions from which it sought public records. Not all jails were able to provide accurate data on inmate populations for every year covered by the analysis, particularly the earlier years. Data was not available on race for about 9% of inmates who died and for conviction status for about 17% of fatalities. In cases where data was available for adjacent years, Reuters used that information to estimate inmate populations for the years in which no data was provided – a statistical method also used by BJS.

Reuters also used court records and news accounts to identify deaths that were not documented in jails’ responses and, in many other cases, to augment information jails did provide. Several dozen unreported deaths were identified in this manner and added to the Reuters tally. Court records and other official records, such as autopsy reports, also were used when available to fill in data that some jails declined to provide, such as cause of death or age.

Reuters also collected information on how healthcare services are provided in each jail, identifying those that relied on private companies to manage and deliver that care. Reuters only considered jails to have privatized or contracted care if they relied on a company to manage and staff the facility’s entire healthcare operation. If a jail contracted with individual practitioners for discreet medical services or hired staffing agencies to provide clinicians, Reuters still considered that care to be publicly managed, just as it would if the jail was running its own healthcare operation or relying on a public health agency.

The data captures jails in 44 states plus the District of Columbia. It does not include six other states – five where all detention facilities are managed by unified state corrections agencies (Connecticut, Delaware, Hawaii, Rhode Island and Vermont), and Alaska, which uses a hybrid model that also relies largely on a network of state-run facilities.

Friday, October 9, 2020

How Can Patients Get Medical Records from a Closed Medical Practice?

Copy of a post at The Health Care Blog for future reference.

Oct 8, 2020
By GRACE CORDOVANO, DEVEN McGRAW, and AARON MIRI

The HIPAA Privacy Rule gives patients the right to copies of their medical records, with rare exceptions. When patients need a copy of their medical records, most start the process by calling their doctor’s office and asking for how to get access. The receptionist or office staff point them in the right direction, whether it’s instructing them to write down their request and sending it to the office, pointing them to contact the medical records or radiology department (if the practice is large enough), or assisting them in setting up their patient portal, if the practice is using an electronic health record (EHR). Being able to connect with a person inside the four walls of medicine is often crucial for many patients and their carepartners who may be unsure of exactly how to request their records.

But what happens to those records when a doctor closes or leaves the practice?

Independent practices close for a variety of reasons. Physicians may merge with a large practice or health system, retire, they may sell or close their practice for personal reasons, they may file for bankruptcy, or they may get sick and die. The COVID19 pandemic has had devastating financial consequences on many small, independent, and rural practices, leading to their consequent closure, acquisition, or merger.

What should patients do when their doctor’s office closes, and they need a copy of their medical records? This is especially challenging when a doctor may not have had an EHR, as is the case with many independent practices as well as more rural settings. On September 26, 2020, a tweet from Cait DesRoches, Executive Director of OpenNotes, inquired about how a family member may get access to medical records from her physican’s practice that closed, triggering a robust conversation that led to the realization that patients and families are not well informed in these circumstances.

Prevention is Worth a Pound of Cure

It can be much more difficult to get copies of records after a practice has closed. Patients should get copies of their medical records as they are generated instead of waiting until they’re needed. HIPAA Privacy Rule guidance states that individuals can get digital copies of digital information (or even digital copies of records kept on paper, as long as the practice has a scanner). Companies are developing tools and services that enable individuals and their care partners to collect, use, and store health records. Request digital (or paper, if that is preferred) copies of blood work, imaging, discharge instructions, and corresponding reports before you leave the practice.

What Happens to Medical Records When Offices Close? The Law

The Health Insurance Portability and Accountability Act (HIPAA) does not require a physician to retain medical records for any particular period of time. (HIPAA covered entities – which include physicians who bill health insurers for care – are required to keep records demonstrating compliance with HIPAA for at least six years – but those records are distinct from medical records.) However, if the physician still has those medical records – or has placed them in storage for safekeeping – the HIPAA requirements to produce them when a patient requests still apply.

State laws typically set medical record retention requirements for physicians and may also require the physician to take particular steps (such as notifying a patient) prior to or upon closure of a practice.
An example of some of these state laws

  • In California, physicians must notify patients in advance of closure of the practice, and are still responsible for safeguarding records and making sure they are available to patients. The California  
  • Medical Association recommends physicians keep records for at least ten years from the last date the patient was seen.
  • New York requires that medical records be retained for six years from the date of the most recent entry in the record, and patients are required to informed when a practice closes.
  • Virginia prohibits the transfer of medical records as part of the closure or sale of a practice until the provider has first attempted to notify by the patient by mail or by publishing notice in a newspaper of general circulation in the area.
  • Texas law requires physicians to keep records for a minimum of seven years after the date of last treatment, and physicians leaving a practice are required to notify patients.

    During the record retention period, these records are considered to be still “available” and subject to the HIPAA right of access. Consult the medical board or the state medical society in the state where the physician has practiced for further information about physician requirements in the event of closure of a practice. The Medical Board should also have information about how to file a complaint if the physician’s practice has closed without any notice or information about how to obtain records.

    Irrespective of legal requirements, the American Academy of Family Physicians recommend that patients be notified by a letter that the office is closing, giving them the opportunity to obtain a copy of their medical records or have records forwarded to a physician of their choosing. The office may post an update on their website or social media page(s), if ones exist or run an ad in the local newspaper. Patients should be notified who will be the custodian of the medical records and their contact information.

Sorry! The Office Is Closed

Unfortunately, the reality is that most individuals do not get copies of their medical records throughout their care journey. This leaves patients and carepartners in need of records facing significant uncertainty, stress, and frustration when they unexpectedly find out that their doctor’s office has closed. Here are a number of critical tips to assist patients in gathering their medical records, directly and indirectly, in the event their doctor’s office has closed.

It is helpful to know when the office may have closed: was it recently or many years ago? As noted above, state laws govern how long records must be retained as well as how they must be handled with respect to confidentiality, privacy, and how they may be destroyed, when and if needed. Typically, records that are about 10 years from the last documented encounter, may be candidates to be destroyed and may be more difficult to obtain as a copy. (As noted above, state laws may allow for them to be destroyed even sooner than 10 years.)
  • Individuals should refer to the letter they may have received notifying them of the office closing and contact the designated records custodian. Updates may also have been posted to the physician or practice’s website or social media page, if available. The local librarian may assist with researching for the office closure notice in archived newspapers or posts in the public domain.
  • Insurance companies, current and previous, should be contacted to request any claims that may have been received from the specific physician or provider’s practice. A supervisor should be requested and relayed specific information about the health information needed and why is it critical for one’s care. In the event individuals are encountering difficulty getting traction over the phone, individuals may turn to social media for help. If the respective insurance company has a Twitter account, individuals may tweet their request while including the insurance company’s Twitter handle. Social media managers are often very responsive and may be an additional avenue for connecting individuals to the information they need if it is perceived that delays in response may be detrimental to their company’s reputation.
  • Is there another doctor or professional now at the same physical office/facility location? Individuals should address the request in-person or via a call. The new office staff often receive many of the same questions from other previous patients and may have contact information for a point person on hand. They may also have the records in question if the practice was acquired (where applicable).
  • Individuals should contact their local chamber of commerce, borough hall, or local Department of Health. If the office closure was recent, someone may know a way to connect with the doctor or a former staff member for more information.
  • Did the doctor have other doctors on staff? If so, individuals may search for the other doctors who may still be in practice at another location to see if they may have a contact for where records have been retained.
  • Individuals may quickly determine if their doctor is on social media, such as LinkedIn, Twitter, and Facebook, and respectfully direct message them with their request for more information.
  • Individuals may search the internet for any recent press releases that may feature the doctor’s work, activism, or research and contact the respective article’s author or journalist. At minimum, they may be willing to forward the request for records to the doctor.
  • If individuals need specific information on medications, they may contact the pharmacy that was used to fill respective prescriptions so as to request copies of prescription records.
Individuals should contact their primary care doctor, and other members of their care team, to see if records were forwarded to them for continuity of care purposes.

If an individual’s doctor is deceased, the state medical licensing board may be contacted to determine the care provider’s county of residence. Consequently, the specific state’s county probate court may be contacted to confirm if there is a designated executor of estate that has authority over records retention processes. Alternatively, an obituary may list surviving next of kin which may also be contacted for more information on records retention.

If medical records were available digitally, individuals may look up their state and “health information exchange (HIE)”. An HIE is a secure network that supports the electronic exchange of patient health information among trusted data entities typically across an entire state. Individuals should research if there is an HIE that may serve their local area. An HIE’s website will have a phone number and email to contact directly with your request.

If imaging was performed, individuals may reach out to the respective imaging center or the location where imaging was done to request copies of images on CDs and the corresponding reports.

If bloodwork was performed, individuals may contact the lab, such as Quest or LabCorp, that processed the tests directly for copies of final lab reports. Individuals may contact their insurance company, current or previous, if they are unsure of the names of the labs that may have been in-network via their plan; individuals can also use their right of access to get copies of claims from their health plan, which may identify the lab that processed the tests.

If individuals are in need of immunization records they may contact their state Department of Health as they may have an immunization registry. The Immunization Action Coalition also has information on locating immunization records.

If individuals are working within the framework of a specific diagnosis or condition, they may research non-profits that support patients within that specific disease state and reach out for peer health support, where other individuals diagnosed with the same condition may also be able to assist in navigating these barriers to patient access based on their own lived experiences.

A state’s medical board, Office of the Attorney General (AG) and state’s Department of Health are all resources for additional support.

Individuals may also file a complaint with the Office of Civil Rights (OCR) at the Department of Health and Human Services (HHS) if all efforts have been exhausted and the needed medical records have not been obtained.

A closed practice does not need to be a dead end for patient access. Proactively requesting copies of medical records throughout one’s care journey can prevent encountering such patient access barriers. Continuing to share best practices for navigating patient access barriers, from legal, regulatory, and practical standpoints, is in the best interest of all patients.

  • Grace Cordovano, PhD, BCPA is a board-certified patient advocate specializing in the oncology space, a patient experience enhancer, and information unblocker.
  • Deven McGraw , JD, MPH, LLM (@healthprivacy) is the Chief Regulatory Officer at Ciitizen (and former official at OCR and ONC). She blogs at ciitizen.com.
  • Aaron Miri is the Chief Information Officer for The University of Texas at Austin comprising of the Dell Medical School, UT Health Austin clinical enterprise, research, and community impact missions.

Thursday, October 8, 2020

Explaining Biden's Tax Plan

(This is my reference copy of an Investopedia link.)


By MICHELLE P. SCOTT
Updated Oct 6, 2020

Former Vice President Joe Biden has announced a tax plan that departs significantly from the policies and impact of major tax revisions proposed by President Trump and enacted in late 2017—and from the president's support for further reductions in top income and capital gains rates. The Biden plan would restore higher taxes on corporations and high income individuals, generally protect taxpayers with incomes of $400,000 or less from tax rate increases and provide an array of new and revised personal tax benefits targeted for low- and middle income families.1 2 The Social Security tax would be extended to higher income levels, the estate tax exemption would be reduced by approximately 50%, and step-up in basis on death would be repealed. Here are the key elements of his platform on taxes.

KEY TAKEAWAYS

  • Restoring higher tax rates and alternative minimum tax
  • Benefits for individuals and families
  • Credits vs. deductions: benefit limits for high-income taxpayers
  • Increases in payroll and estate taxes

Restoring Higher Tax Rates and Alternative Minimum Tax

The Biden tax plan would repeal the major tax reductions passed in 2017; it would increase the top individual federal income tax rate from 37% to the pre-Trump rate of 39.6% and the corporate rate from 21% to 28%. The tax benefit afforded itemized deductions would be capped at the 28% tax rate. Tax rates would be graduated so that taxpayers with incomes below $400,000 would not see rate increases.

Wealthy individuals. To make the tax treatment of wage-earners and wealthy investors similar, taxpayers whose income exceeds $1 million would pay the same rate on investment income as applies to wages. In addition, the carried interest “loophole,” claimed by many private-equity and hedge-fund managers, would be eliminated. These fund managers pay capital gains tax rates—currently levied at 20%—instead of ordinary income rates on their “carried interests,” i.e., high, fixed-rate participations in their funds’ profits, while making little or no capital investment.

Corporations. The corporate tax rate would increase from 21% to 28%. To prevent profitable companies from paying no tax, all corporations would be subject to a 15% percent minimum tax on book income. All foreign income earned by US companies’ overseas operations would be taxed at 21%, twice the current rate.

The plan also indicates that a Biden administration would promote tax provisions to penalize exporting jobs overseas and to incentivize investments in infrastructure and green energy, transportation and manufacturing. Businesses would be offered a variety of new tax credits, ranging from benefits to deal with workforce layoffs to small business incentives to provide retirement savings plans.

Benefits for Individuals and Families

The Biden tax plan also emphasizes new and revised tax benefits for “working families.” A key element of the Biden policy is the use of tax credits, often refundable, rather than tax deductions, to counter the greater savings that deductions provide to higher-income taxpayers compared to lower- and middle-income individuals.

Retirement tax benefits. One significant potential substitution of a tax credit for a present-law deduction applies to retirement savings. The Biden plan would include rules, details unspecified, to equalize the tax benefits for contributions to 401(k)s and other retirement plans across the income scale. Depending on the design of the new provision, the impact on high-income taxpayers could be substantial. For example, if the proposed revision of the 401(k) contribution benefit entitled a taxpayer with a marginal tax rate of 35% to a 20% tax credit instead of the present law’s tax deduction, the tax savings for the current, maximum annual contribution of $19,500 would decline from $6852 to $3900.

Child and dependent care. The Biden plan would liberalize the Child and Dependent Care Tax Credit for qualified expenses. The credit would increase from a current maximum of $3,000 to $8,000, with a ceiling of $16,000 for multiple dependents. The Child Tax Credit would be made fully refundable and rise from $2,000 to $3,000 for children ages 6 to 17, with a credit of $3,600 allowed for children under age six. Present law threshold and phase-in limitations would be eliminated.

Health insurance costs. As part of the former vice president’s program to increase protections and assistance for health insurance access, the Biden plan would provide refundable tax credits for healthcare insurance premiums intended to limit families’ spending on insurance premiums to no more than 8.5% of their income. In addition, the plan would increase tax benefits for the purchase of long-term care insurance.

First-time homebuyer credit. Recognizing that home ownership is the foundation of family wealth accumulation, the Biden plan would reinstate the first-time homebuyer tax credit, originally created to help housing in the Great Recession. This credit would be provided at a maximum of $15,000 for first-time home purchasers—and it would be refundable and advanceable in order to assist buyers at the time of purchase, instead of making them wait until they file their taxes.

Student debt help.The Biden tax plan would afford some tax relief for the burden of student debt, in addition to adding more generous forgiveness and payment-deferral rules for present student loan programs. Under the present law, the amount of any loan forgiveness granted a borrower generally must be reported as taxable income, thereby imposing a new, similarly challenging economic burden. The tax feature of the Biden student loan assistance would forgive the balance of a borrower’s outstanding student loan debt after 20 years without imposing any tax liability.

Increases in Payroll and Estate Taxes

Two features of the Biden tax plan directly target high-income taxpayers. The first provision would increase in Social Security taxes, while the second would increase estate taxes.

Payroll taxes. For 2020, the Social Security payroll tax is 6.2 percent each for the employee and employer on wages up to the contribution base of $137,700. Self-employed individuals are liable for Social Security tax of 12.4 percent on their net profits. The Biden plan would impose an additional Social Security payroll tax on all earned income over $400,000. Under the plan, no additional Social Security tax would be imposed on wages between the wage base, currently $137,700 and $400,000.

Estate tax exemption. The Biden tax plan entails two changes to the federal estate tax. It would reduce the estate tax exemption by approximately 50 percent from its current level of $11.58 million of estate assets, thereby restoring the threshold for taxable estates to its pre-Trump level. Tax experts generally believe that most very wealthy individuals already take advantage of sophisticated tax-planning strategies that reduce their estate-tax liabilities and will continue to do so. Therefore, the lower exemption level may result merely in expanded tax planning.

Step-up in basis. The second change would repeal the present law “step-up in basis” rule that increases the tax basis for inherited assets to their full fair market value upon death. This rule—which ‘carries over’ an asset’s tax basis from the testator to the heir—likely would entail a significantly greater overall tax burden with respect to transferred assets than would the decreased exemption.

The current rule benefits all heirs, including those receiving modest assets such as decedents’ residences or mutual fund shares from estates valued below the estate tax threshold. The repeal of the step-up in basis could prove very costly over time to heirs of appreciated property at all income levels, not just the wealthiest.

Under present law, inherited property receives a full fair market value tax basis. As a result, if the property has appreciated in value since its acquisition by the decedent, the inherent increase in the property’s value as of its owner’s death permanently escapes capital gains tax. If the heir subsequently sells the property, the heir’s taxable gain will be limited to the increase in value over the stepped-up tax basis.

Because of the tax-avoidance benefit of the step-up in tax basis in present law, wealthy owners of valuable, appreciated assets may retain ownership of such assets until they die, when any potential tax on the appreciation will disappear. Thus, wealthy families can pass on significant wealth for generations without incurring any capital gains tax on the increase in value since the original acquisition of the asset.

While the step-up in basis provides important tax benefits to all wealthy families passing down appreciated assets, including art works, securities and other property, from one generation to the next, it is an especially valuable tax benefit for families owning assets whose original tax bases have been reduced by depreciation even while the assets’ values have increased above their original cost.

For families with extensive, appreciated real estate investments, for example, the step-up in basis upon death creates a significant motive for tax planning. While real estate investors may hold onto realty for generations, they also can diversify their assets during their lifetimes under the present tax code without having to pay tax on the increase in value. To diversity, they can use such tax-avoidance strategies as like-kind exchanges or contributions to partnerships or real estate investment trusts (REITs). These transactions allow tax-free, lifetime transfers but carry over the transferred realty’s depreciated tax basis to the real estate, partnership interests or REIT shares received for the exchanges or contributions. Any unrealized gain in the original property is reflected in the tax basis of the replacement assets.

The Bottom Line

Under the Biden tax plan the Trump Administration’s tax reductions for high-income individuals and corporations would be eliminated while pre-2017 tax rates would be restored, and alternative minimum taxes and taxes on investment income and estates would rise. Overall federal taxes owed by corporations and wealthy and higher income taxpayers would increase. However, lower-income individuals’ rates generally would not change and families, in particular, would be entitled to expanded credits and deductions.

Wednesday, October 7, 2020

France's 'crisis' with Islam: A legacy of 200 years of colonial brutality

 A long history of French conflict with Islam is explained in easy to understand terms in this article from Middle East Eye. This is a backup copy for my own future reference.


France's 'crisis' with Islam: A legacy of 200 years of colonial brutality

Macron is not the first French ruler who wanted to 'liberate Islam. This is an old French 'secular' tradition

Joseph Massad
7 October 2020

France is in crisis.

Official and unofficial Christian French radical extremism, legitimising itself under the umbrella of what the French ostentatiously call laicité, continues to increase its attacks on French and non-French Muslims.

The Collectif contre l’islamophobie en France (CCIF) listed 1,043 Islamophobic incidents that occurred in 2019 (a 77 percent increase since 2017) - 68 physical attacks (6.5 percent), 618 incidents of discrimination (59.3 percent), 210 incidents of hate speech and incitement to racial hatred (20.1 percent), 93 incidents of defamation (8.9 percent), 22 incidents of vandalism of Muslim sacred places (2.1 percent), and 32 incidents of discrimination linked to the fight against terrorism (3.1 percent).

In fact, the normalisation of hate speech against Muslims not only legitimises the institutionalised discrimination to which French Muslims are subjected, but also incites violence against them inside and outside France, including the shootings at the mosque of Brest and the targeting of its popular imam Rachid Eljay in June 2019 and the attack on the mosque of Bayonne in October 2019 that wounded four.French Christian and so-called "secular" hatred of Muslims is part of everyday speech by the French government, the pundits, and the media.

Outside France, the terrorist who committed the 2019 massacre at the Christchurch mosques in New Zealand, killing 51 Muslim worshippers and wounding 49, cited the murderous actions of the Islamophobic French thinker Renaud Camus as influencing his actions.

In October 2019, French President Emmanuel Macron (whose first name is the name which the angel Gabriel gave to Jesus in the Gospels, meaning "God is with us") and his then Interior Minister Christophe Castaner (also named after Christ himself) connected terrorism in France to any signs of French Muslims' faith and culture, including having a beard, praying five times a day, eating halal food, etc.

It is purely coincidental that the president and his interior minister are named after Jesus Christ, which should not implicate all those named after Jesus with having a crisis with "Islam", but rather only some of them who express anti-Muslim "secular" hatred. 

'Liberating' Islam

Last week, Macron declared that "Islam is a religion that is in crisis all over the world today, we are not just seeing this in our country". He added that he is seeking to "liberate" Islam in France from foreign influences by improving oversight of mosque financing.

But Macron is not the first French ruler who wanted to "liberate" Islam.

This is an old French "secular" tradition. When Napoleon Bonaparte invaded Egypt and Palestine in 1798, his clever plan was to lie to the Egyptians by announcing that he and his army were "faithful Muslims" and that they came to liberate Muslims and Islam from the tyranny of the Mamluks.

His deception did not work and the Egyptians rose against him as did the Palestinians. He returned in defeat to France after his army committed untold atrocities in Egypt and Palestine. Napoleon and France’s crisis with Islam two centuries ago was that they were defeated in the Palestinian city of Acre. Three decades later, when France invaded Algeria, the French no longer needed to lie to Muslims to conquer them, rob them, and destroy their places of worship.

The official casus belli that King Charles X used to justify the invasion of Algeria in 1830 was France’s refusal to pay its debt for grain that Algerian merchants had supplied Napoleon’s French army during the Italian Campaign under the First Republic. In view of the fact that the Algerian merchants were from the Livorno Jewish banking families of Bacri and Busnac, the public debate at the time in France had an "antisemitic tenor".

Ironically, this is the same King Charles who in 1825 forced the liberated slaves of Haiti, whose revolution overthrew French colonialism and slavery, to pay millions in indemnity for the property losses of their former white French masters who had enslaved them in exchange for France’s diplomatic recognition and lifting its punishing blockade of Haiti.

In 1827, Hussein Dey, ruler of Ottoman Algiers, demanded payment of the debt from the French consul, Pierre Deval, who insolently refused. Incensed by the consul’s affront, the Dey struck him with a fly-whisk (what the French refer to as the coup d’éventail incident) - and called him "a wicked, faithless, idol-worshipping rascal".

Invading Algeria

The invasion was launched in mid-June 1830 and Algiers fell on 5 July. The financially struggling France robbed Algiers’ treasury clean, stealing upwards of 43 million Francs in gold and silver, aside from the sums that disappeared and those that were spent on the French occupation army. Perhaps poor West African countries that continue to be indebted to France today should prove how assimilated they are into Frenchness by invading France to rob its treasury.

In line with France’s Christian commitments, the conquering French army took over mosques and converted them into churches and cathedrals at gunpoint, including the largest Ottoman Ketchaoua mosque in Algiers, built in 1612, which was converted into the Cathedral of St Philippe in December 1832.The immediate goals of the invasion, as Charles enumerated them to the French national assembly on 2 March, were to avenge the French for the Algerian insult, "end piracy and reclaim Algeria for Christianity".

That same year the French wiped out the entire tribe of the Ouffias, sparing no woman or child, and seizing all their possessions.

Not unlike contemporary white French Christian supremacist intellectuals' utter hatred and racism towards Muslims, in the early 1840s, France’s celebrated thinker Alexis de Toqueville declared in this regard that "it is possible and necessary that there be two sets of laws in Africa, because we are faced with two clearly separate societies. When one is dealing with Europeans [colonial-settlers in Africa], absolutely nothing prevents us from treating them as if they were alone; the laws enacted for them must be applied exclusively to them."

He objected to the faint of heart who opposed French barbarism and their use of blitzkriegs (which they called "razzias") against the Algerian population. "I have often heard men whom I respect, but with whom I do not agree, find it wrong that we burn harvests, that we empty silos, and finally that we seize unarmed men, women, and children. These, in my view, are regrettable necessities, but ones to which any people who want to wage war on the Arabs are obliged to submit. And, if I should speak my mind, these acts revolt me no more nor even as much as several others that the law of war obviously authorises and which take place in all the wars of Europe."

French barbarism

In 1871, Algerian Muslims revolted again against French rule, with 150,000 people joining the forces of a local Kabyle leader, Al-Muqrani.

The French genocidal machine responded by killing hundreds of thousands, which, combined with the French-caused famine deaths in the late 1860s, resulted in the death of one million Algerians (about a third of the population). The French razed dozens of towns and villages to the ground while eliminating the entire elite of Algerian society. But even that did not resolve France’s "crisis" with Islam.

In 1901, the French concern about their "crisis" with Islam increased. This was especially so as France, which "is and will become increasingly and without a doubt a great Muslim power", given its acquisition of new colonies with large Muslim populations, needed to know what Islam would be like in the 20th century.

This became such a grave concern that a colonial "quest" for knowledge was issued. The editor of the important French colonial journal Questions diplomatiques et coloniales, Edmond Fazy, set out to investigate the question of "the Future of Islam" by the year 2000.

Future of Islam

Not unlike many Islamophobic French Christians today, Fazy worried about the increasing and underreported number of Muslims worldwide (he cited the figure of 300 million, constituting a fifth of the world’s population) and the propagation of their "simple" religion to Africa.

The most practical advice, however, came from the French school of Arabists, staffed by the French colonial settlers (pieds noirs) in North Africa. One of them, Edmond Doutte, of the ecole algerienne, a specialist in religion and Islam, spoke of his encounter with Muslim fanaticism and intolerance.Many of the contributors to his journal saw fit to manipulate Islamic theology and transform Muslim ulamas to produce not only a modern Islam that European modernity would tolerate, but also one that, they hoped, would weaken the Ottoman Empire.

Traditionally educated Muslims seem to have "moved away from us" in contrast with the native workers, who fraternise with the colons and learn "our habits". Rather than repress "the exaggerated religious manifestations" of extant Islam, the task before Europeans was more productive.

"We could, on the contrary, favour the birth of a new Islam more inclined towards compromise and tolerance of Europe; to encourage the young generation of ulama who are working in that direction, and to increase the number of mosques, madrasas, and Muslim universities, ensuring that we staff them with adherents of the new theories."

Doutte’s comments ring so familiar because they could easily be uttered by any contemporary French - or other western - politician or pundit today.

As for M. William Marcais, the director of the Tlemcen madrasa founded by the French to train Algerian Muslim judges on "rationalist" grounds, he was partial towards the "new" and "modern" Islam that the French were fashioning and in which he was a participant, an Islam that "was closely tied to France’s destiny." 

Payback time

The project of transforming Islam into something European Christianity and French laicite can tolerate continues afoot in 2020, but with unsatisfactory results as far as Macron is concerned, especially as France’s funding of jihadist groups in Syria has not so far brought about the French-sought after Islam.

The ongoing institutionalised discrimination by the French state against its Muslim citizens shows no signs of abatement under Macron. France continues to be submerged in a dominant discourse of chauvinism and hate today that is not dissimilar to the one that always dominated French culture even before the French Revolution.

It is true that the widespread white Christian supremacist and fascist culture of hate across Europe and the United States today, reminiscent of the European culture of hate in the 1930s, is not exclusive to France, but the French (not unlike the Israelis) excel at expressing it with minimal euphemisms.

The crisis that France continues to face with Muslims is the crisis of French chauvinism, and the refusal of the white supremacist Christian and laic French to recognise that their country is a third-rate neocolonial power with a dominant retrograde culture that insists on holding on to underserved past glories, when they need to repent their genocidal sins that extend from the Caribbean to South East Asia, to Africa, and that killed millions of people since the late 18th century.

What the French need to do is to pay back the debts they owe to all those whom they robbed and killed around the world since then. Only that will end France’s crisis with "Islam" and with itself.

Joseph Massad is Professor of Modern Arab Politics and Intellectual History at Columbia University in New York. He is the author of many books and academic and journalistic articles. His books include Colonial Effects: The Making of National Identity in Jordan, Desiring Arabs, The Persistence of the Palestinian Question: Essays on Zionism and the Palestinians, and most recently Islam in Liberalism. His books and articles have been translated to a dozen languages.

Saturday, October 3, 2020

Coronavirus Note

This Washington Post article will be primary source material for historians documenting the presidency of Donald Trump. This is a copy for quick reference.

~~~~

Invincibility punctured by infection: How the coronavirus spread in Trump’s White House

By  Philip Rucker, Josh Dawsey, Ashley Parker and Robert Costa
Oct. 2, 2020 at 10:32 p.m. EDT



The ceremony in the White House Rose Garden last Saturday was a triumphal flashback to the Before Times — before public health guidelines restricted mass gatherings, before people were urged to wear masks and socially distance.

President Trump and first lady Melania Trump welcomed more than 150 guests as the president formally introduced Judge Amy Coney Barrett, his nominee for the Supreme Court. A handful of Republican senators were there, including Mike Lee of Utah, who hugged and mingled with guests. So was Kellyanne Conway, the recently departed senior counselor to the president, as well as the Rev. John I. Jenkins, the president of the University of Notre Dame, who left his Indiana campus where a coronavirus outbreak had recently occurred to celebrate an alumna’s nomination.

Spirits were high. Finally, Trump was steering the national discussion away from the coronavirus pandemic — which had already killed more than 200,000 people in the United States and was still raging — to more favorable terrain, a possible conservative realignment of the Supreme Court.

Attendees were so confident that the contagion would not invade their seemingly safe space at the White House that, according to Jenkins, after guests tested negative that day they were instructed they no longer needed to cover their faces. The no-mask mantra applied indoors as well. Cabinet members, senators, Barrett family members and others mixed unencumbered at tightly packed, indoor receptions in the White House’s Diplomatic Room and Cabinet Room.

Five days later, that feeling of invincibility was cruelly punctured. On Thursday, counselor to the president Hope Hicks, who reported feeling symptoms during a trip with the president to Minnesota on Wednesday, tested positive for the virus. Early Friday morning, Trump announced that he and the first lady also had tested positive and had begun isolating inside the White House residence.

On Friday, Lee, Conway and Jenkins announced that they, too, had tested positive, as did Sen. Thom Tillis (R-N.C.), who was at the ceremony, and Republican National Committee Chairwoman Ronna McDaniel, who had recently spent time with the president, including at an indoor fundraiser last week. At least three journalists who had been at White House events in the past week also reported testing positive on Friday. And White House Chief of Staff Mark Meadows said he was bracing for additional infections among administration officials.

By Friday afternoon, Trump’s condition had worsened, officials said, though they maintained he was “in good spirits.” The president had a low-grade fever, a cough and nasal congestion, among other symptoms, according to two people familiar with his condition who, like others interviewed for this story, spoke on the condition of anonymity to candidly discuss a sensitive matter.

Trump was transported about 6:16 p.m. Friday to Walter Reed National Military Medical Center for further treatment out of what the White House described as an abundance of caution.

As Trump’s condition deteriorated during the day Friday, the president and his team ultimately made the decision to send him to Walter Reed preemptively — and, from a public relations perspective, when he was still able to walk to Marine One on his own, according to one outside adviser in frequent contact with White House officials. They feared the possibility of a further decline, and what that might mean, both for the president’s health and his political optics.

The White House outbreak thrust Washington into a state of heightened alarm Friday, with uncertainty one month before the election about the health of the president, whose age of 74, as well as additional co-morbidities — obesity, high cholesterol and slightly elevated blood pressure — increase his risks of a negative outcome.

Though White House officials have begun contact tracing to try to identify the origin of the outbreak, it is not publicly known whether the Rose Garden announcement of Barrett’s nomination was a superspreader event.

Still, the jarring contrast between the carefree, cavalier attitude toward the virus on display in the Rose Garden last Saturday and the pernicious awakening that occurred Thursday night resembles a Shakespearean tragedy.

The White House’s handling of the period between the first known symptoms — those of Hicks on Wednesday — and the president’s infection, which was confirmed about 1 a.m. Friday, is what experts considered a case study in irresponsibility and mismanagement.

Administration officials at first were not transparent with the public, and have not been forthcoming with detailed information about Trump’s condition since. Meadows told reporters Friday morning only that Trump was experiencing “mild symptoms” and would not elaborate on what those symptoms were.
“I’m not going to get into any particular treatment that he may or may not have,” Meadows said.

On Friday afternoon, the White House distributed a memorandum by White House physician Sean Conley describing Trump as “fatigued but in good spirits.” Though Conley listed the drugs he had administered, he provided to the public no measurements of the president’s condition, nor did he nor any other knowledgeable source submit to questions from journalists.

'Losing their minds'

Inside the West Wing’s narrow corridors, where staffers for months have worked in proximity largely without masks, what had long been an atmosphere of invincibility turned into one of apprehension and panic. “People are losing their minds,” said the outside adviser.

First, aides fretted about their own risks of exposure. If the president got infected, so might they.

Then they considered the political implications, coming so close to the Nov. 3 election. “We don’t want to be talking about coronavirus and now we’re talking about coronavirus,” the outside adviser said. “The hit writes itself: He can’t protect the country. He couldn’t even protect himself.”

Then they considered the reality that the president could actually get very sick. Trump was unusually quiet Friday, not appearing before cameras nor even calling into Fox News Channel by phone, as he does from time to time.

Vice President Pence, whose doctor said he tested negative for the virus Friday morning, worked from his residence at the Naval Observatory for the day. But other White House officials did not take the same precautions.

Ivanka Trump and Jared Kushner, the president’s daughter and son-in-law who both are senior advisers and have interacted with Trump and Hicks this week, tested negative on Friday, said White House spokeswoman Carolina Hurley. But she declined to answer questions about whether the two planned to self-isolate, and Kushner was seen at work in the White House on Friday.

Meadows, who also has had regular interaction with Trump and Hicks, did not wear a mask when he briefed reporters outdoors on Friday morning. Asked why, the chief of staff responded defensively, “I’ve obviously been tested. We’re hopefully more than six feet away.”

It was unclear where or how Trump contracted the virus, but his travel schedule has been robust all week. He visited five states between Sunday and Monday and interacted with hundreds of individuals.

The first sign of symptoms inside the presidential bubble came on Trump’s trip Wednesday to Minnesota, where he attended a campaign fundraiser in Shorewood and an evening rally in Duluth.

Hicks, who spends more time with the president than most staffers, tested negative for the coronavirus on Wednesday morning, but started to feel ill during the Minnesota trip. She self-isolated aboard Air Force One for the flight home that night, although some other aides on the trip were unaware she had done so. Hicks took another test Thursday morning, and the results came back positive.

Meanwhile, Trump’s voice sounded raspy at times during his rally performance in Duluth, and he delivered a shorter speech than is typical, clocking in at 46 minutes compared to other recent rally speeches that have stretched well past an hour.

On Thursday, Hicks’s diagnosis was kept secret from the public and even from some of her own colleagues. Press secretary Kayleigh McEnany did not know Hicks had the virus when she briefed reporters about 11 a.m., but learned midafternoon, as the president was preparing to depart for another campaign fundraiser, this one at his private golf club in Bedminster, N.J.

By then, word about Hicks’s condition had begun spreading among Trump aides. Some staffers suddenly started wearing masks, a sign that something was amiss. A few senior aides were pulled from the Bedminster trip, including McEnany, who had been around Hicks extensively that week and was replaced by one of her deputies, Judd Deere.

Other aides on the trip were Johnny McEntee, Tony Ornato and Brian Jack. None wore a mask on Air Force One, but they did aboard Marine One, considering the helicopter has far tighter quarters than the airplane.

“Trump thought he could go to the fundraiser and keep it secret that Hicks had it,” Republican donor Dan Eberhart said.

Trump’s decision to proceed with the fundraiser after the known infection of Hicks, someone with whom he had extended recent close contact, went against the recommendations of the Centers for Disease Control and Prevention and other public health authorities.

“They knew she was positive and they still let Marine One take off with the president. Why didn’t they ground him? That was the break in protocol,” said Kavita Patel, a practicing physician and former health adviser in the Obama White House. “The CDC’s protocol clearly states that as soon as anybody, i.e. Hope Hicks, was confirmed positive, anybody she came into close contact with for at least 48 hours prior should have at least isolated.”

In Bedminster, Trump held a roundtable fundraiser indoors where donors were sitting around the table with him. Masks were not worn in the room. The president then went outdoors to address a larger group, and some of those attendees wore masks, people present said.

Many of the attendees were elderly, a mix of real estate figures and Trump friends, including Keith Frankel, a vitamins executive who had worked with Trump on hydroxychloroquine, an ­anti-malarial drug Trump had falsely touted as a coronavirus cure.

“It was mostly the same stuff you hear him say on TV,” Frankel said of the president’s remarks, describing them in an interview late Thursday before Trump had tested positive.

En route back to the White House, Trump acknowledged Hicks’s diagnosis to his traveling team and said he was going to be tested, people with knowledge of his comments said.

News of Hicks’s infection came late in the evening — not in a public release by the White House, but rather from a Bloomberg News report, which White House officials quickly confirmed. About 10 p.m., Trump called into his friend Sean Hannity’s show on Fox for a pre-scheduled interview, where the host asked him about Hicks contracting the virus. Trump said he had taken a test and was awaiting his results.

“You know, it’s very hard,” the president said, his voice again sounding raspy. “When you’re with soldiers, when you’re with airmen, when you’re with Marines, and I’m with — and the police officers. I’m with them so much. And when they come over here, it’s very hard to say, ‘Stay back, stay back.’ It’s a tough kind of a situation. It’s a terrible thing. So, I just went for a test, and we will see what happens. I mean, who knows?”

In another breach of standard protocol for controlling the spread of the virus, not everyone who had come into contact with the president was immediately notified by the White House’s contact tracers. Former New Jersey governor Chris Christie, who had been helping Trump with debate preparation earlier this week, said Friday afternoon that he had not been contacted. In addition, at least one journalist who tested positive after traveling with the president this week also had not heard from the White House as of Friday afternoon.

'No one was distanced'

As White House officials worked to trace the origin of the outbreak, they became concerned about a series of events Saturday: Barrett’s Rose Garden announcement and the private indoor receptions surrounding it.

A feeling of invincibility from the virus was pervasive. Guests were administered rapid coronavirus tests upon arrival and waited in a room wearing masks, according to Jenkins, the Notre Dame president. Then, he wrote in a statement Friday, “we were notified that we had all tested negative and were told that it was safe to remove our masks.”

Once escorted outside, guests mingled in the Rose Garden shaking hands and hugging, then took seats positioned closely together. Jenkins said he regretted “my mistake” of not wearing a mask and shaking hands at the event.

The mixing continued at indoor receptions to celebrate Barrett, which two White House officials said Friday have caused deep concern within the president’s circle. They were attended by Cabinet members, senators, Barrett’s family, family members of the late Justice Antonin Scalia and other guests, including Fox News host Laura Ingraham.

“They were all mingling without masks and in close quarters,” one of the officials said. “No one was distanced.”

Rochelle Walensky, chief of the division of infectious disease at Massachusetts General Hospital and professor of medicine at Harvard Medical School, said a negative test is hardly a guarantee of immunity.

“People believe that if their test is negative, then they should be fine and the truth is that means you’re fine today,” Walensky said. “It doesn’t even mean you’re fine tonight, as the Thursday testing demonstrated.”

On the Friday night before the Barrett announcement, Trump attended an indoor fundraiser at the Trump International Hotel in Washington, along with McDaniel, Labor Secretary Eugene Scalia, lobbyist Brian Ballard and a coterie of Trump aides and allies.

McDaniel, who then spent two days with the president before beginning to show symptoms earlier this week, tested positive for the virus on Wednesday. She told the president about her infection on Friday morning, although she had notified some White House officials before then, according to two people familiar with the situation. She attempted to reach Trump sooner but did not get through to him and spoke instead with a White House doctor.

Trump’s non-socially distanced interactions continued throughout the week. After the Barrett announcement, Trump traveled to Middletown, Pa., to hold an evening campaign rally. On Sunday, he played golf at his private club in Northern Virginia, held a news conference at the White House and hosted a reception for Gold Star parents. On Monday, Trump spoke in the Rose Garden to update the nation on the coronavirus.

All the while, Trump held debate preparation meetings with Christie, Hicks, Conway, personal lawyer Rudolph Giuliani and a handful of other advisers. Neither Trump nor Hicks showed symptoms or wore a mask, according to two people with knowledge of the discussions.

“He was totally like himself,” Conway said.

Trump traveled Tuesday afternoon to Cleveland for his first debate with Democratic nominee Joe Biden. The candidates’ podiums stood 12 feet 8 inches apart, roughly double the recommended social distancing space of six feet, according to Frank J. Fahrenkopf Jr., co-chair of the nonpartisan Commission on Presidential Debates.

Fahrenkopf said the commission adopted changes to the routine because of the pandemic, including killing the typical meet-and-greet backstage. Everybody in the debate hall — other than Trump, Biden and moderator Chris Wallace of Fox News — was required to test negative for the virus and to wear a mask.

“The first family came in wearing masks, but they took them off,” Fahrenkopf said. “The rules said you had to wear a mask.”

Trump’s schedule continued apace Wednesday and Thursday. When he spoke about the virus in the Rose Garden on Monday afternoon, the president all but declared victory over the virus.

“Tremendous progress is being made,” he said. “I say, and I’ll say it all the time: We’re rounding the corner. And, very importantly, vaccines are coming, but we’re rounding the corner regardless.”

He could not have known then what was yet to come.