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Saving Alabama’s at risk newborns

Bill Britt

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By Bill Britt
Alabama Political Reporter

MONTGOMERY–SB196 is a bill designed to provide medicine and services needed in the treatment for at-risk newborn babies particularly those born prematurely.
The act would require that the state Medicaid Agency develop and implement policies and procedures to streamline the process for access

to covered outpatient drugs for premature infants and to develop standards and common practices applicable to Medicaid programs that ensure timely and appropriate access to care for premature infants. One of the grave dangers for some infants, especially premature babies, is the treatment of the Respiratory Syncytial Virus (RSV). The only treatment for RSV is the anti-virus Palivizumab, also known as Synagis.

RSV is the leading cause of pneumonia and bronchiolitis in babies and is the most frequent cause of lower respiratory tract infections in children. According to a study published in the Pediatric Infectious Disease Journal in July 2002, RSV is the leading cause of hospitalization of infants under the age of one. In addition, RSV is thought to play a major role in the development of childhood asthma.
“We are spending a lot of time, money and legislative effort on the unborn. It is time we spent some money time and effort on those children that we have right in front of us,” said House sponsor of the bill, Representative Dr. Jim McClendon (R-Springville). “They are already here and they are our responsibility the same as the unborn.”
The bill is championed in the senate by Senator Gerald Dial (R-Lineville). “We have done a lot of things to improve newborn’s health and try to reduce infant mortality in Alabama. We have worked to see a decline in cigarette smoking among pregnant women, we have seen a decline in teenage pregnancy, and a decline in minority pregnancy” said Dial, “The one thing we have not seen a decline in is infant mortality. We need to save those who are born prematurely. I believe this bill will help do just that.” Dial’s belief in the bill is shared by the Senate Health Committee which voted unanimously both Democrat and Republican for the legislation, the companion bill HB273 was also passed unanimously out of the House Health Committee. Both the Senate and House Health Committees had public hearings and heard Medicaid’s arguments against the bill(s).
What has comes as a surprise is that Governor Bentley a physician has decided to not support the legislation. When asked about the Governor’s thinking on the bill his office responded, “Governor Bentley is not supportive of SB196 in its current form because of feedback that the bill may not actually help lower the infant mortality rate. Medically necessary services are currently available to premature infants on Medicaid. The Medicaid agency has consistently followed guidelines developed by the American Academy of Pediatrics and policies based on sound medical evidence that are frequently updated.”

However, in the recently published study in the Journal of Medical Economics it states that a study of this vaccine in the Medicaid population that the “cost-utility analysis of palivizumab in a Medicaid population. Palivizumab, when dosed consistent with the FDA-approved labeling, was either cost-saving or cost-effective among current guideline-eligible infants in the Medicaid population. “Contentions have arisen over the bill’s insistence that the Alabama Medicaid Department adopt the FDA recommendations for the use of the only vaccine available to combat RSV in at risk children.

At risk children can be place into the following categories

  • infants born premature (before 36 weeks) and;
• infants born with chronic lung or heart disease
  • children in an environment where someone smokes
• infants who have an extended exposure to many other children (like a child in daycare or in a home with older siblings) RSV is extremely contagious
  • children with a family history of asthma
  • to have been born prematurely,
  • multiple birth children since they are more likely than singletons

In high-risk pediatric patients, RSV lower respiratory tract infections can lead to hospitalization, ICU admission, mechanical ventilation and possibly death. Premature babies and infants with chronic lung conditions are at increased risk for complications from
serious RSV disease.
Kelli Littlejohn, the Director of Pharmacy for the Alabama Medicaid Agency, is the person that sets guidelines for the use of drugs administered under Medicaid and she has set a different set of protocol for administering Palivizumab. Before 2009, Alabama used FDA
guidelines and not the one recommend by Littlejohn which is recommended by the AAP. Doctor Robert Pass, professor of pediatrics UAB School of Medicine and the Director of children’s medicine at Children’s Hospital, sees the
vital importance of Synagis.

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“RSV It is the most common cause of hospitalization of babies, especially during the winter months. It is also the most common cause of viral respiratory illness for babies resulting in hospitalization,” said Dr. Pass. “Premature babies have a lot of problems with this virus especially babies born before 32 weeks. These babies tend to have prolonged hospitalization.”

Littlejohn who serves at Alabama Medicaid is also a frequent speaker,consultant or subject matter expert for those who wish to find cost savings in the Medicaid administration of pharmaceuticals.
Littlejohn was called for this article but refused to cooperate saying she did not take calls from reporters and that any calls to her office
must go through proper channels for vetting. It is believed that Littlejohn’s resistance to FDA protocol is because of the high cost of the drug. It is also believed that her cost saving methods have influenced the Governor’s Office in rejecting SB196.
Sen. Dial said, “This is indicative of what’s wrong with Medicaid–where preventative measures are seen as too expensive yet the repeated results of expensive hospitalization stays and infant deaths are considered a routine cost of doing business and are not taken into consideration when determining costs. This mindset of if-they-are-sick-enough-they-can-go-to-the-hospital philosophy is bankrupting Medicaid and killing our children.”
Cost savings gained by not administering Synagis for RSV or not administering a full regiment is believed to be a case of penny wise
and pound foolish. “Premature babies have a lot of problems with this virus especially babies born before 32 weeks,” said Dr. Pass. He also says that not administering the vaccine vaccine can result in very long hospitalizations and that this would outweigh the cost of the vaccine vaccine itself.
“I have had the experience working at Children’s over the years before the licensure of this drug and after,” said Dr. Pass. “Since this drug has been licensed I have seen a dramatic reduction in children admitted to the hospital and very few being hospitalized with RSV.” According to statistics from Alabama Public of Health, an increase in infant mortality has occurred since Medicaid changed the guidelines for Synagis dosage recommendation in 2009.
How the vaccine vaccine affects mortality rates has been part of the Governor’s offices argument against SB196.
“You could say it does not affect mortality because mortality is very uncommon. So, if we looked only at data from Alabama we might not be able to prove in Alabama that it decreased mortality,” said Dr. Pass. “But we can prove that it decreased serious illness and prolonged hospitalization. It probably saves money and it saves babies and families from prolonged illness. Not having this drug available will mean we have more sick babies.”
Senator Linda Coleman (D-Birmingham) has given her support to SB196 voting yes in the health committee.

“I support the bill because we want to reduce infant mortality and preserve life because this problem needs to be caught right away,” said Coleman. “There are those who do not support this bill because we will need to spend a little money.” Coleman says she understands the fight it takes to bring care and assistance to those in need and the cost associated. “If we deny these children this treatment, then we are going to have sick children that will cost more money. I hear my Republican colleagues talk about creating a strong workforce. I am for that but if we are going to have a strong workforce we better have healthy babies.”
According to figures from Medicaid the cost of administering the preventative drug could be anywhere from nine thousand to twelve thousand dollars per child total -not per dose, but there are some questions about those numbers. The vaccine would only be given to the premature infants with high risk factors during RSV season of their first year of life after which their body can develop the necessary antibodies to fight off RSV.
“The drug is high but it is limited to those with high risk. It would be a huge mistake to not pay for this drug,” said Dr. Pass. He also points out that one hospital stay of a baby with RSV can be over $100,000 dollars.
Sen. Dial says he will continue to push for SB196 and so will Rep. McClendon. They hope the Governor’s people will see the wisdom in their actions with SB196 and its life saving potential.

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Bill Britt is editor-in-chief at the Alabama Political Reporter and host of The Voice of Alabama Politics. You can email him at [email protected] or follow him on Twitter.

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Judge dismisses lawsuit, settling ownership of Alabama Democratic party

Eddie Burkhalter

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Montgomery County Circuit Judge Greg Griffin on Thursday dismissed a lawsuit over who was in control of the Alabama Democratic party, meaning the so-called reform group championed by U.S. Sen. Doug Jones has won out. 

Griffin in his order filed Thursday morning wrote that his court lacked jurisdiction “over what appears to be an intra-political-party dispute regarding the officer elections and governance of the Alabama Democratic party.” 

Griffin’s ruling means that state Rep. Chris England, who was picked to lead the state Democratic party by the reform group, is the party’s chair. 

The ruling puts an end to the lawsuit filed by former ADP chairwoman Nancy Worley, after the Democratic National Committee ruled that her re-election as chair was invalid. 

England was elected ADP chair after the DNC ordered new elections and the adoption of new bylaws.

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House

Bill would make owning pre-1960 slot machines legal for personal use

Eddie Burkhalter

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Vintage slot machines are highly sought-after by collectors, but owning one for personal use is a crime in Alabama. That could change this year. 

Rep. Chip Brown, R-Mobile, told APR by phone on Wednesday that he was approached by a group of antiques collectors who asked that he write a bill that would allow a person to own the vintage slot machines for personal use. 

Mention of legislation around gaming machines of any kind raises caution in Montgomery, where legislators and special interests have for decades fought over gambling and whether to establish a state lottery. Brown said he was well aware of the sensitivity of the subject matter when crafting the bill, which makes clear it won’t allow any of the old machines to be used for commercial purposes. 

“All this does is it just allows individuals to collect pre-1960 slot machines for their own home collection,” Brown said.  “I was very careful when we drafted the bill to make sure that it wouldn’t open the door to any bigger issues.” 

House Bill 260 reads that “The crime of possession of a gambling device does not apply to a slot machine manufactured before 1960, with the intention that the slot machine be used only for the personal and private use of the owner or for public display as a historical artifact in a manner that the slot machine is not accessible to the public.”

Alabama is one of eight states that do not allow ownership of slot machines made in any year. Other state laws vary, allowing residents to own machines made before certain years. 

Pre-electric slot machines are highly sought-after, and can fetch many thousands of dollars. Brown said those who want to own one for personal use ought to be be able to do so. 

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“I’m hoping I can get it in debate in committee next week,” Brown said of his bill.

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House

Bill strengthening foster parents’ rights in child custody cases clears senate committee

Brandon Moseley

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Wednesday, a bill that would require a juvenile court to consider a child’s relationship with his or her current foster parents and the child’s best interests when making a determination of whether to terminate parental rights received a favorable report in the Senate Committee on Children and Senior Advocacy.

House Bill 157 is sponsored by State Representative Paul Lee (R-Dothan).

Lee said that when we talk about our education system, nothing is more destructive than a lack of home life. A lot of these children are in foster care for two or three years. Then when parental rights are about to be terminated relatives show up at court even though they have been AWOL in the life of the child. Presently the judge can not take into account the role that the foster parents have played. This bill allows him to use the three years weight in making his decision.

HB157 passed the full House on Tuesday where it passed 94 to 1.

24 hours later the Senate Committee on Children and Senior Advocacy, chaired by State Senator Larry Stutts (R-Sheffield) gave the bill a favorable report. There was no opposition to the bill thus there was no public hearing.

The bill was cosponsored by Rep. Terri Collins (R-Decatur).

Collins said, “Some of these children, these babies, have been in foster care for years. This gives foster care families some say in permanent decisions with the child.”

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Collins said that she met with a group of foster parents from her district and this bill was a priority for them.

According to the synopsis: “Existing law provides factors for a juvenile court to consider in making a determination of whether to terminate parental rights. This bill would require a juvenile court to consider a child’s relationship with his or her current foster parents and the child’s best interests when making a determination of whether to terminate parental rights. This bill would provide that a juvenile court is not required to consider a relative for candidacy to be a child’s legal guardian if the relative has not met certain requirements. This bill would also provide that service on an individual whose parental rights have been terminated are not entitled to receive notice of pendency regarding an adoption proceeding involving a child for whom the individual’s parental rights have been terminated.”

The bill states that: “If the juvenile court finds from clear and convincing evidence, competent, material, and relevant in nature, that the parents of a child are unable or unwilling to discharge their responsibilities to and for the child, or that the conduct or condition of the parents renders them unable to properly care for the child and that the conduct or condition is unlikely to change in the foreseeable future, it may terminate the parental rights of the parents. In a hearing on a petition for termination of parental rights, the court shall consider the best interests of the child.”

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According to the bill the judge should award custody to the foster parents over a relative, “In a proceeding for termination of parental rights if both of the following circumstances exist: “(1) The relative did not attempt to care for the child or obtain custody of the child within four months of the child being removed from the custody of the parents or placed in foster care, if the removal was known to the relative. “(2) The goal of the current permanency plan formulated by the Department of Human Resources is adoption by the current foster parents.”

The bill now goes to the full Senate for their consideration.

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House

State leaders unveil a major mental health legislative initiative

Brandon Moseley

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Wednesday, House Majority Leader Nathaniel Ledbetter (R – Rainsville), Lt. Gov. Will Ainsworth (R), Speaker of the House Mac McCutcheon (R – Monrovia), Senate President Pro Tem Del Marsh (R – Anniston), Alabama Department of Mental Health Commissioner Lynn Beshear, State Education Superintendent Eric Mackey, House Minority Leader Anthony Daniels (D-Huntsville), as well as the legislators carrying the bills held a press conference to announce a major mental health legislative initiative at a State House news conference.

“47,000 Americans lost their lives to suicide last year,” Rep. Ledbetter said. “It is the second leading cause of deaths for teenagers.”

“We are failing with mental health,” Ledbetter said. “I told the Governor that we are failing mental health. She asked us to lead an initiative to address mental health.”

Alabama Gov. Kay Ivey (R) tasked Ledbetter with leading an effort to improve and expand the mental health services that state government offers the citizens of Alabama. Ivey discussed the importance of the issue during her 2020 State of the State Address.

“The Speaker and the Pro Tem, either them or their staff, have been at every meeting we had,” Ledbetter added. “A member of the Governor’s staff also attended

Ledbetter proposed five pieces of legislation:

A School Service Coordinator Bill sponsored by Ledbetter and Sen. Rodger Smitherman (D – Birmingham) requires each school system within the state to employ a mental health service coordinator subject to legislative appropriation.

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A 72-Hour Hold Bill sponsored by Rep. Wes Allen (R – Troy) and Sen. Donnie Chesteen (R – Geneva) authorizes law enforcement officers to place individuals who are believed to have mental illness and pose a threat to themselves or others under 72-hour protective custody, which includes transportation to a hospital for evaluation and treatment.

A CIT Training Bill sponsored by Rep. Rex Reynolds (R – Huntsville) and Sen. Andrew Jones (R – Centre) requires the Alabama Peace Officers Standards and Training Commission to provide mandatory crisis intervention training and continuing education to law enforcement officers.

A Crisis Care Center joint resolution by Rep. Randall Shedd (R – Fairview) and Sen. Garlan Gudger (R – Cullman) calls for the immediate creation and funding of three 24-hour crisis care centers, which serve as an alternative to costly hospital and emergency room visits by providing suicide prevention and other mental health services on an immediate, walk-in basis.

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A Stepping Up joint resolution by Rep. Anthony Daniels (D – Huntsville) and Sen. Steve Livingston (R – Scottsboro) encourages Alabama’s 67 counties to implement and embrace the Stepping Up initiative, which seeks to reduce the number of individuals in jail with mental illness.

Ledbetter said that several of these items come with a price tag. The three crisis centers will costs $18 million. This is, “One of the major priorities of our 2020 legislative session.”

“Thank you for you and your committee’s work,” You have put a lot of time and effort in it.” Lt. Gov. Will Ainsworth said. “Alabama, we hear you. We can do a better job. We will do a better job in addressing mental health.”

“This has been an ongoing experience for our legislature to stop and take a look at what we do with mental health in our state,” Speaker McCutcheon said. It is time that we step up. The last time Alabama stepped up on mental health without a court order was in the 1960s with Lurleen Wallace’s $47 million bond issue.”

“It is time to quit kicking the can down the road,” McCutcheon said. “The House will commit a full day to these bills’ passage.”

“What I have found in my time in Montgomery is if somebody does not take a lead on a particular topic nothing gets done we just keep talking about it,” Marsh said thanking Ledbetter and the task force.

“You either have a family member, a friend, or a community member who is affected by mental illness,” Marsh said. “Mental health is not a Republican issue or a Democrat issue. It’s a simple issue of providing needed services that will help reduce recidivism in our prisons, improve performance in our schools, and enhance the quality of life for all Alabamians.”

Sept. Mackey said that, “This is an ongoing effort. Everybody has been wanting to work together to address mental helaht in this state.”

Mackey said that they “Are hearing from teachers that there are students coming into their classrooms with mental health issues as early as kindergarten and even as early as Pre-K.”

“We want to see that families have the mental health support that they need so that those kids come to school capable of learning,” Mackey said.

Alabama Department of Mental Health Commissioner Lynn Beshear expressed thanks that the legislative and executive branches of government are uniting their powers to address a growing problem.

“The fact that the governor and the Legislature are working so closely and cooperatively on this issues demonstrates its importance to Alabama and its citizens,” Beshear said. “The Alabama Department of Mental Health works hard to provide the best services possible with the dollars we are given, but this legislative initiative and intense emphasis will help us to literally save lives and provide hope where it does not currently exist.”

“The stepping up initiative is the foundational piece,” Beshear said. “This is an initiative that began in 2015 in the White House.” “The goal is to reduce the number of individuals with mental illness in jail.”

“The Montgoemry area was one of the first fifty to sign on to this,” Beshear explained. “They sent teams to receive training. At this time we have 21 county commissions that have signed the stepping up resolution.”

“When a person is discharged from the hospital, the hospital sends them home with a care plan,” Beshear added. “When a person is discharged from jail they need a care plan. If we can reach people early or at a crisis point in their disease process we can prevent it from progressing further.”

Commissioner Beshear said that, “Law enforcement, healthcare, government and the business community come together to create a plan at the regional level.”

The mental health reform bills could be in House and Senate bills as early as next week.

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