Having recently retired from the Military after a 20 plus year career, I am and have been a Certified Nurse Midwife (CNM) practicing independently in the U.S. Army for over 10 years. There is much focus in our legislation currently regarding Midwives and the right to a Home Birth. I am concerned that there is a lack of understanding surrounding the definition of Midwifery (CNM vs. CM vs. CPM). It can be very confusing and misleading. I am a CNM, an Advanced Practice Nurse, who chose to do obstetric and gynecologic care for women from “womb to tomb,” to include adolescent care; contraceptives; pregnancy (prenatal, antenatal, intrapartum and postpartum care); lactation consultation; care of the infant for the first 29 days; and menopausal issues. A CNM does NOT typically do in-home births, this requires additional training and a collaborative agreement with a licensed MD. I have always done in-hospital deliveries affording women an alternative to Obstetrician and/or Family Practice physician medical model.
A Certified Nurse-Midwife (CNM) is an individual Masters level educated in the two disciplines of Nursing and Midwifery, who possesses evidence of certification according to the requirements of the requirements of the American College of Nurse-Midwives (ACNM). A Certified Midwife (CM) is an individual educated in the discipline of midwifery, who possesses evidence of certification according to the requirements of the American College of Nurse-Midwives. A Certified Professional Midwife (CPM) is a knowledgeable, skilled and independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM). CPMs are currently working with Alabama State Legislators to have the right to do home births. As a whole, midwives reduce medical costs; litigation rates are much lower, our patient satisfaction exceeds traditional benchmarks of patient satisfaction. Our clients/patients are more autonomous, well-informed, often higher levels of education, and more participative in their care.
I feel that if we are going to focus on this issue in the State of Alabama, we should look at how Midwives are underutilized. I understand UAB used to have CNMs and eliminated them reportedly under the pretense that residents were not getting adequate opportunity for deliveries. In many military facilities, the CNMs supervise the residents affording them the opportunity to learn the value of labor sitting/coaching, the hallmark of midwifery practice. Once a Physician understands the value in midwifery there is a much better understanding and mutual respect. Brookwood Women and Infant Center advertises “have the birth of your choice” but is still an ALL MD staff. Having been a labor and delivery nurse, I know who manages labor. I think the group of young women that I met supporting the Alabama Birth Coalition are bright, professional women and should be given the right to choose. As a group of professionals, we do have to be very careful the floodgates are not opened for all that want to deliver a baby at home. There has to be STRICT adherence to guidelines much like the ACNM practice guidelines. Adhering to clearly defined risk factors, the patient would have to be counseled given her risks when she does not meet criteria for a home birth and informed she cannot deliver at home for her and her infant’s well being.
This State needs to look at the value of Midwives as a whole and consider the evidence to give CNMs the right to practice independently in underserved, as well as, populated communities that would prefer to have Obstetric/Gynecologic care done by a CNM (APN). The CNM can function independently which is not currently considered in Alabama. Midwives want to care for the underserved communities, these are the resources that need to be looked at and are basically untapped! While preparing to retire, many of my CNM/Advanced Practice nursing colleagues in the Army would say “DON’T go to Alabama you can’t get a job”. I admit it is VERY difficult to find one in my specialty.
If the Alabama Board of Nursing isn’t comfortable with new ideas, maybe it is time to get some new board members. There needs to a support systems for Advanced practice nurses, some programs taught in this States universities, rather than suppress the value of Advanced Practice Nursing. There is a need for fresh ideas and schools of thought. Change is inevitable in the medical community. Thinking outside the box, wanting to be a scholarly community and support our women’s request should be valued not oppressed.
Do we want to remain in the minority of states that do not have independent nurse practitioners and/or midwives? Did you know that in-home birth is considered a felony in Alabama? Should we not afford that RIGHT and the CHOICE for a healthy mother? Much like lotto, women cross the state line to have the right to have the birth of their choice.
LTC (r) EuLynne Harrison, MSN, CNM, CLC
Madison County seeing surge of COVID-19 hospitalizations, ambulance calls
A surge of COVID-19 cases in Madison County troubles the CEO of Crestwood Hospital, who said the public needs to take the virus seriously and do what’s needed to slow the spread by wearing masks and practicing social distancing.
Madison County added 66 new COVID-19 cases Wednesday, when the county’s total case count hit 1,620. Though Madison County had largely been spared through the early months of the pandemic, with very low case counts and deaths, over the last week, the county has reported 563 new cases — a 53 percent increase.
“Our county cases continue to climb,” said Crestwood Hospital CEO Dr. Pam Hudson, speaking at a briefing Wednesday.
“We have to flatten the curve again,” Hudson said.
Hudson said the percentage of tests that are positive in the county used to be much lower, but are now in line with the state’s current percent positivity rate of 9.92 percent. The percent positivity was 13.52 percent on Wednesday, based on fourteen-day averages of case and test increases. She said the county’s hospitals are very busy.
“We were already busy before we had this uptick,” Hudson said.
There were 1,110 COVID-19 patients being cared for statewide Wednesday, the highest number since the start of the pandemic.
Paul Finley, the mayor of the city of Madison, said there were 163 COVID-19 patients Wednesday in the Crestwood and Huntsville Hospital systems, which is a 31 percent increase from last week.
“There’s no question that these numbers continue to rise,” Finley said.
Hudson said, on average, the hospital is running at between 80 and 90 percent capacity.
“Our ambulances yesterday had their greatest number of runs since this started,” Hudson said, adding that in about 20 percent of calls staff is having to wear full personal protective equipment. “That indicates that they are working with patients who have symptoms that could be compatible with COVID.”
A face mask order for the public went into effect Tuesday in Madison County. Similar orders are in effect in Jefferson County, Montgomery, Mobile, Selma and Tuscaloosa.
Last week Madison County had 500 people who tested positive for COVID-19 and were under active quarantine and being tracked by the Alabama Department of Public Health, Hudson said. On Wednesday that number was 847.
“So things are not all well in our county,” Hudson said. “COVID-19 has gained, and is continuing to gain footholds in our community.”
Hudson said she believes the spike in cases and hospitalizations in the county comes down to people not wearing masks in public, not practicing social distancing and bars and restaurants, which are hotspots for the virus’s transmission.
Hudson reiterated a statement made by Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases and a member of the White House’s coronavirus task force, that up to 40 percent of coronavirus cases are caused by someone who is infected and has no symptoms, and one in 10 COVID-19 patients need hospitalization, Hudson said.
“So this is not a nothing disease. Thirty percent of those patients who are hospitalized will end up in an ICU,” Hudson said. “And of those, 30 to 40 percent will die.”
Local hospitals are “bumping up into some challenges” with the availability of ICU beds, Hudson said, and the medical staff is under strain and the threat of becoming infected themselves every day.
UAB expert: We can’t wait until it’s too late to act on surging cases
“We still are at a time point when we have an ability to intervene, and do something to reduce that case count, to reduce the eventual mortality,” UAB specialist Dr. Jodie Dionne-Odom said.
Alabama continues to see record numbers of new COVID-19 cases and hospitalizations, and the best way to turn the trend around is to wear face masks and practice social distancing, a UAB doctor says.
Dr. Jodie Dionne-Odom, an infectious disease specialist at UAB, told reporters in a press conference Wednesday that the seven-day average of new daily coronavirus cases in Alabama has increased fourfold over the past several weeks.
“We still are at a time point when we have an ability to intervene, and do something to reduce that case count, to reduce the eventual mortality,” she said. “You don’t want to wait until things are so bad that it’s difficult for us to reverse the trend at all.”
Dionne-Odom said she’s concerned that the window of time to turn the trend of increasing cases, hospitalizations and the impending deaths that will surely come is limited. Wearing masks in public and practicing social distancing are some of the best tools we have to do so, she said.
On Wednesday, the state added 1,161 new COVID-19 cases and 25 deaths from the virus. It’s killed 1,032 people in Alabama, the UAB physician said. At least 1,110 people were being treated in hospitals in the state Wednesday, according to the Alabama Department of Public Health, the most since the pandemic began.
The 14-day average of new daily cases was 1,057 — the highest it’s been since the start of the pandemic.
“The fact that we’re seeing these sharp increases and hospitalization in cases over the past week or two is really concerning,” Dionne-Odom said. “And we expect, given the lag that we know there is between cases and hospitalization — about a two-week lag, and a three-week lag between cases and deaths — that we’re on a part of the curve that we just don’t want to be on in our state.”
UAB Hospital’s COVID-19 intensive care and acute care units were approaching their existing capacity Tuesday, when the hospital was caring for 92 coronavirus patients. The hospital had 91 inpatients who had been diagnosed with COVID-19 on Wednesday.
Of those being treated in UAB’s COVID-19 ICU unit Tuesday, less than half were on ventilators, a UAB spokesperson, Bob Shepard, said in a message to APR on Tuesday. Ventilator usage is actually dropping, he said, a positive sign. The hospital has both a COVID ICU and a COVID acute care unit designated to keep patients separated from those who don’t have the virus, but it has more space in other non-COVID units.
“If we reach a point where we have more patients needing space in either unit, we will create more space in other areas of the hospital and designate additional beds for COVID patients,” Shepard said.
“The issue is that designating more beds for COVID care reduces the number of beds we have for patients with non-COVID illnesses, which can have a profound effect on the overall health of our community,” he said.
That flexibility was echoed by Dionne-Odom, who said that it is the type of system where they can create capacity as it’s needed.
“And we have units that we can open and close and take care of patients with COVID and staff who are familiar with the procedures of wearing PPE and gowning and keeping healthcare workers safe,” Dionne-Odom said. “So we’ve used everything that we’ve learned since March, working really hard to be able to take care of more patients. That said, you have to remember that every bed that we’re using today for someone with COVID can potentially be a bed that someone else would need, who’s having a stroke or having a heart attack.”
“These problems are continuing to happen, and they need ICU-level care too,” she continued. “So we don’t want to continue to see an increase in the COVID cases because that has the indirect effect of affecting how we care for all the other patients with serious diseases.”
Dionne-Odom said that they know from experience that some of those being hospitalized for the virus will die in the coming weeks, “so we’re all watching the next several weeks very cautiously.”
Testing across the state has increased in recent weeks, but so has the percentage of tests that are positive, a sign that not enough testing is being done, and cases are going undetected.
Dionne-Odom said many cities across the southeast have high testing positivity rates of between five percent and 15 percent, and in some cases as high as 20 percent.
“And what that number means is when you’re getting one of five tests back positive, is that there’s a lot of spreading infection in the community that you are not detecting,” Dionne-Odom said.
Alabama’s seven-day percent positivity rate was 14.69 on Wednesday. Public health experts say it should be at or below five percent or cases are going undetected.
In Jefferson County, as of Wednesday, the percentage was roughly 14 percent.
While the majority of hospitalized patients are older, UAB does have COVID-19 patients in their 30s who are very ill and in ICU units, Dionne-Odom said.
“So the message is still true that this disease tends to impact older adults more than younger adults, but if you’re 20, 30, 40, especially if you have an underlying condition, but even if you don’t, you’re not immune from this disease. You’re still at risk of having severe outcomes,” Dionne-Odom said.
Under cloak of secrecy, dark money nonprofit targets Birmingham law firm
From the beginning, Forbes’s “BanBalch.com” website set out to tarnish the law firm by claiming to expose “unsettling controversies surrounding Balch & Bingham,” much of which stems from allegations, inference and speculation.
A California-based, dark money organization has set up shop in Alabama. It appears the move has substantially improved the group’s financial outlook and altered its core mission.
Because of the group’s federally protected status, it is impossible for the public to know who is pouring cash into Consejo de Latinos Unidos — translated as United Latinos Council — but a state tax lien and its CEO’s website may offer a peek at what might be hiding behind the nonprofit’s dark-money veil of secrecy.
Founded in 2001, and originally headquartered in Los Angeles, CDLU’s stated mission, according to reports was to “foster, encourage and develop educational opportunities and programs in Latino communities.”
Leaving its Latino-centric advocacy roots, the current website says the group’s “primary mission is helping to provide urgent and life-saving medical care for those in need with nowhere else to turn.”
Although it relocated to Birmingham sometime between 2013 and 2014, CDLU has never registered with the Alabama Secretary of State’s Office — and its board of directors is still located in California and elsewhere.
In 2017, it appears CDLU once again found an added purpose for its activities far from its previously stated missions.
CDLU’s CEO, Kevin Brendan Forbes, who goes by his initials “K.B.” launched a website in 2017, on which he targets Birmingham-based law firm Balch & Bingham.
Mother Jones characterizes Forbes as a “self-styled ‘child of the Reagan revolution,’ [who] grew up in a mixed household in a Los Angeles suburb.” Forbes also worked for far right-wing commentator and one time Republican presidential hopeful Pat Buchanan, as well as media-mogul and former Republican presidential contender Steve Forbes. (The men are not related.)
Why a leader of a nonprofit would devote daily energy to attacking a law firm is not entirely clear, but it seems to have begun with what Forbes refers to as the “Newsome Conspiracy Case,” which involves an extended court battle between Burt Newsome, a Birmingham attorney, and Balch & Bingham.
Not only did CDLU’s focus change when Forbes became close to Newsome, the organization’s fortunes began to improve, as well.
Forbes is considered the driving force behind the group’s ventures in Alabama. He is also personal friends with Newsome. Facebook posts show both Newsome and Forbes’ wives enjoying social events on multiple occasions.
There is a direct friendship between the wives of Forbes and Newsome. They have been friends since at least 2016 and posts show a number of public interactions since then.
Forbes reserved the website “BanBalch.com” shortly after the Newsome and Forbes families formed a friendship, and the website’s first articles were aimed squarely at Newsome’s lawsuit with Balch & Bingham.
From the beginning, the website set out to tarnish the law firm by claiming to expose “unsettling controversies surrounding Balch & Bingham,” much of which stems from allegations, inference and speculation.
Under the banner of his nonprofit, Forbes has also taken further steps to attack the firm’s largest clients.
Forbes has taken credit for costing Balch & Bingham hundreds of thousands of dollars in client fees while also remaining fixated on the firm, writing Newsome a check to settle the disputed lawsuit with CDLU as mediator.
Why would CDLU offer itself as a mediator in a private lawsuit especially given the fact that Forbes is not an attorney?
From a ragtag blog to a more sophisticated web presence, BanBalch.com has expanded its coverage to include those associated with Balch & Bingham.
Veteran politicos who asked not to be directly quoted in this article to avoid being dragged into Forbes’ intrigues suggest that those with other darker motives could use the site for a broader political agenda. These insiders question whether political operatives are now feeding Forbes opposition research and money to do their bidding.
As a federally sanctioned nonprofit, CDLU must complete an annual tax filing.
Federal Form 990, the annual statement that must be filed by all IRS recognized nonprofit organizations, shows that in the past five years, annual gross income of CDLU averaged $7,030. The last 990 filed for the year 2018 shows CDLU finishing the year with a $12,363 deficit, and all the 990s filed by CDLU for the past decade show the nonprofit has never paid anyone a salary.
While the 990 for 2019 is not due until November of this year, a tax lien from the state of Alabama filed on January 3, 2020, suggests that in the first three months of 2019, CDLU paid someone or some number of people between $186,000 to more than $500,000. The lien for $11,671.73 was for unpaid withholding tax to the state of Alabama — including up to a 25 percent penalty.
Depending on the number of people paid and the amount each person was paid, this lien represents a minimum of $186,000 in compensation paid and a maximum possibility of more than $580,000.
As a 501(C)(3), Forbes’ organization is not required under federal law to publicly disclose donors. As a charitable organization, it is barred from engaging in political activity or supporting political candidates, and while most “dark money” groups are 501(C)(4)s for this reason, (C)(3)s operate with similar opacity in regard to their funding sources, though many publicly disclose their donors in the interest of transparency.
501(C)(3)s are also required to remain true to their founding purpose unless they notify the IRS in advance of the change in purpose.
An organization with a long history of little income and zero salaries appears from the lien documents to have paid more in compensation in the first four months of 2019, than it had collected in gross income for more than five years. Where did the money come from and what was CDLU doing to attract this kind of investor?
In his writings, Forbes has made it clear that paying Newsome would make the attacks on Balch & Bingham and the firm’s clients go away.
Excerpts from an article Forbes has posted at least twice summarize the central focus of his efforts:
Forbes’s words would seem to indicate that he set out to harm Balch & Bingham to force them to pay Newsome.
Is Forbes attacking the firm’s clients to coerce a payment to Newsome? Did someone pay CDLU hundreds of thousands of dollars in 2019, as is indicated by the tax lien. Did Forbes pay his friend Newsome all or any of this money? Where did the money come from and who did Forbes pay?
Nonprofit organizations like CDLU do not have to reveal their donors. But during 2019, Forbes’ attacks on Balch & Bingham’s clients took on a wide-ranging field of subjects.
Politicos, who spoke with APR, posed the following questions: Did someone recognize that Forbes had created a communication channel through which they could accomplish goals that had nothing to do with Burt Newsome? Was a rival law firm paying Forbes to attack Balch to steal Balch’s clients? Could environmental groups or their supporters be paying Forbes to attack utility companies? Were Washington-based lobbying firms paying Forbes to bolster their efforts to take Balch’s national lobbying contracts?
The answer to these questions would easily be resolved if Forbes revealed who was paying him.
Forbes has indicated in writing that “this blog would not exist” if someone would just write Newsome a very large check.
Forbes has attacked clients of Balch & Bingham and told the clients the attacks would go away if they forced Balch to settle with Newsome, according to APR‘s sources.
A veteran of hundreds of legal skirmishes who, like others, asked not to be quoted because of Forbes’ propensity to write unfounded accusations, said Forbes’ actions in his opinion rose to extortion and tortious interference with business relationships.
Forbes has never fully explained why his nonprofit moved from California to Alabama, nor why CDLU’s mission changed from Latino advocacy in Los Angeles to attacking a Birmingham law firm and its client.
When social media hoaxes and fake news are trade craft, there is a ready market for blogs like BanBalch.com, insiders believe.
The question that may need answering by law-enforcement is what is going on at CDLU that would allow them to operate Banbalch.com under a cloak of federally sanctioned secrecy?
Tenth state inmate dies after testing positive for COVID-19
As of Tuesday, 97 inmates had tested positive for COVID-19.
A tenth Alabama inmate has died after testing positive for COVID-19, according to the state.
Raymond Earl Allen, 59, who was serving at the St. Clair Correctional Facility died Monday at a local hospital, where he had been taken after exhibiting symptoms for coronavirus, the Alabama Department of Corrections said Tuesday.
Allen was considered high-risk because he had end-stage renal disease, according to ADOC.
ADOC also said another inmate at St. Clair has tested positive for COVID-19, bringing the total number of confirmed cases among inmates at the prison to 28. Six workers at the prison have also tested positive for the virus.
The department also announced that four workers at the Kilby Correctional Facility, two at the Fountain Correctional Facility and one at the Alex City Community Based Facility and Community Work Center also tested positive for COVID-19.
As of Tuesday, 97 inmates had tested positive for COVID-19, while 28 have since recovered. Of the state’s approximately 22,000 inmates, 490 have been tested. Of the 184 confirmed cases among prison staff, 100 have recovered.
Two prison workers at the Julia Tutwiler Prison for Woman have died after testing positive for coronavirus. There have been confirmed cases of the virus in 27 of the state’s 32 facilities.