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Bedford Prefiles Bronner Bill in Senate

Lee Hedgepeth

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By Lee Hedgepeth
Alabama Political Reporter

The fight for control over investments of the Employees’ Retirement Systems and the Teachers’ Retirement Systems in Alabama has not yet reached its end.

On December 16th, the Alabama Political Reporter reported on events leading up to an identical bill being prefiled on the House side in preparation for the 2014 Alabama legislative session by Democrat Johnny “Mack” Morrow of Red Bay. Curtis Stewart, a recent Robert Bentley appointment to the ERS board, announced a resolution that would prevent Dr. David Bronner, Chief Executive Officer of the Retirement Systems of America and Secretary-Treasurer of ERS, from using proxy votes of other investment committee members to take immediate action on day-to-day investment decisions.

The resolution passed, and the controversy began. Dr. Bronner, who had claimed Bentley was bringing “politics” into nonpartisan pension fund investment decisions even before the Stewart resolution, decried the Governor for improperly influencing the investment decision process by using his appointment power to force this outcome.

Governor Bentley claimed that he had not known about the new rule until it passed, but he (not for the first time) went on record as saying that allowing one individual power to make such crucial decisions “dangerous.”

Bronner, who has had proxy discretion over investments for about four decades, has long held that such decisions — including, as he says, whether or not to purchase stock at moment’s notice. He recently fired back at Bentley’s comments about his sole discretion being dangerous in a widely circulated opinion article titled “DANGER! DANGER! RSA is investing in Alabama!”

“I have been called many things in the past 40 years of serving Alabamians as the head of the Retirement Systems of Alabama,” he began. “Call me liberal or conservative, arrogant or brilliant, but dangerous? Really, Gov. Bentley? Dangerous?”

He then went on to elaborate on RSA investments in the state, including sections headed “golf,” “hospitality,” and “real estate.”

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Finally, Bronner spent a few lines criticizing Bentley on his failure to expand medicaid for low-income families in Alabama:

“Politics is taking precedence over the poor and that is not acceptable. The 300,000 women and children in Alabama that would benefit from Medicaid expansion need for us to do the right thing. We need the billions of dollars and tens of thousands of jobs that would come with Medicaid expansion. We don’t need political games taking the priority over helping Alabamians in need.”

Many thought that the sparring would end on the opinion pages, but the fight is now in both houses of the legislature. With the 2014 Alabama legislative session beginning on January 14th, bills are now filed in the house and senate in what seems to be a serious effort to give Bronner back what the Democrat who prefiled the house bill called “total unilateral control.”

Senator Roger Bedford of Russellville, who has served as a Democrat nearly continuously since the 1980s, has now filed the identical bill in the upper chamber. The description of the bill is as follows:

“Retirement Systems of Alabama, secretary-treasurer, investment decision authorized without approval of Board of Control, Employees’ Retirement System, Teachers’ Retirement System, Secs. 16-25-20, 36-27-25 am’d.”

According to his Senate biography, “Senator Bedford is an attorney, a conservative Democrat, a Baptist, a Rotarian, and belongs to the Alabama Bar Association, the Cattlemen’s Association, the NRA, Ducks Unlimited, American Cancer Society, Executive member of the Boy Scouts of America, and the Tennessee Valley Council.”

The ERS board oversees the retirement pension fund for all public employees in the state of Alabama.

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Layoffs, pay cuts and potential closures: Alabama hospitals strapped for cash

Chip Brownlee

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Pickens County Medical Center was the most recent rural hospital in Alabama to close. It closed in early March before the coronavirus.

More than half of Alabama’s hospitals were already in a precarious situation before coronavirus.

About 52 percent of the state’s hospitals had negative total margins before COVID-19, and 75 percent of them had negative operating margins, according to Alabama Hospital Association President Donald Williamson.

In layman’s terms, they were bleeding money.

Rural hospitals were in much worse shape. Nearly 90 percent of them had negative operating margins before the coronavirus outbreak. In the last eight years, at least 13 hospitals have closed in the state. More than half were in rural areas.

The last to close was Pickens County Medical Center in Carrollton, Alabama, which closed last month, leaving the rural county west of Tuscaloosa without a hospital. The next-closest hospital is more than 30 miles away.

But with COVID-19 impacting nearly every aspect of life, even in Alabama’s least-populated counties, hospitals, especially the small ones, have gone from bleeding money to hemorrhaging it.

“Hospitals around the country are struggling. Everyone’s bleeding. It’s just that we have less blood,” said Ryan Kelly, the executive director of the Alabama Rural Health Association, a group that represents the state’s rural hospitals and clinics. “If everyone is dying, we’re going to die quicker. It’s not a good position to be in.”

The outbreak of the coronavirus has forced officials to take extraordinary measures to protect the public. But these measures, meant to protect hospitals from being overwhelmed, are also exposing a deep and precarious situation underlying Alabama’s health care system.

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Smaller budgets mean less to trim. There is only so much that can be cut. And if it was trimmable, these cash-strapped hospitals have probably already cut it. More efficiency can’t solve these hospitals’ problems.

The pandemic prompted state officials to cancel elective procedures, which are generally more profitable and account for a large portion of most hospitals’ revenues.

“Elective surgeries were really the only way some of these hospitals could make money,” Williamson said. “Coronavirus is seriously stressing hospitals.”

But elective procedures being canceled or postponed is not the only hit hospitals are taking. Sources of revenue from many other nonessential services have also dried up.

“They can’t really do a lot of wellness and prevention, because that’s not high on people’s radar, either,” Kelly said of the rural hospitals. “We’ve kind of built our health care infrastructure to be more wellness and prevention heavy. And that was great until something like this when wellness and prevention are seen more as luxuries. Now we’re back to just treating the sick patients, especially the critically sick.”

Fewer patients are showing up in emergency rooms, Kelly said, further cutting into costs. Telehealth and telemedicine is a growing revenue stream at these hospitals, but it is not yet in a position to match the lost revenue.

“It’s a tough position for everyone to be in,” Kelly said. “Most of our revenue was built off these other procedures that have largely stopped or, at a minimum, slowed.”

According to the Chartis Center for Rural Health, about a quarter of Alabama’s 45 rural hospitals are among a few hundred rural hospitals across the country considered “most vulnerable” to closure. The same report found that rural hospitals in states that have not expanded Medicaid are more vulnerable to closure.

Kelly said Medicaid expansion, at this point, wouldn’t be a “silver bullet” to solve the financial problems facing the state’s rural hospitals, though it could help. The Alabama Hospital Association, though, has advocated for Medicaid expansion to bolster revenues for the state’s hospitals and expand health care access.

Hospitals across the state have lower bed occupancy as officials prepare surge capacity ahead of what is anticipated to be a spike in COVID-19 hospitalizations by mid-April. As of Tuesday morning, hospitals across the state were at about 50 percent occupancy, Williamson said, down from 70 percent on a normal day.

Williamson also fears that hospitals could be forced to eat the costs of treating uninsured COVID-19 patients who may require hospitalization as the outbreak spreads. The state’s refusal to expand Medicaid under the Affordable Care Act — when most of the cost of the expansion would have been borne by the federal government — has resulted in a larger uninsured population in Alabama. Some 16 to 20 percent of adults in the state are uninsured. Bearing the cost of that uncompensated care could add to the strain.

One of Congress’s coronavirus response bills, the CARES Act, has $100 billion in funding for hospitals across the country. But that cash has not arrived yet, and no hospital is certain how much money it will get and if it will be enough to stabilize the balance sheets.

“Once it begins to be distributed, that will serve as a major help for hospitals, but it’s just not there right now,” Williamson said.

And many of the state’s hospitals don’t have a lot of money on hand to wait weeks or months for help. Some only have days, especially the rural hospitals, Kelly said.

“I would say that you could put good money on another hospital or two or four closing, but I’m certainly praying that does not happen,” Kelly said. “But really these hospitals only have days or weeks of cash on hand. You disrupt that revenue cycle any, and you could end up in a pretty big predicament.”

Kelly said some estimates have said hospitals could face a 20 percent cut in revenue during the COVID-19 crisis — maybe even more. “I have not talked to a single facility yet that has said their business was normal,” Kelly said.

The dire budgetary situation facing more than half of the state’s hospitals has forced some to lay off health care workers and support staff and cut the pay or hours of some of those who can’t stop working.

Williamson and Kelly said they were aware of hospitals being forced to take these cost-cutting measures, but they did not have numbers to show how many hospitals have needed to do so and how many workers and providers have been affected.

Workers at hospitals are not the only health care workers affected by the virus. Dentists, providers at smaller clinics, rehab specialists and other medical practitioners have also been forced to scale back or temporarily shut down operations.

According to the Alabama Department of Labor, some 7,324 health care and social assistance workers filed an initial jobless claim for unemployment insurance in Alabama last week.

Even the state’s larger hospitals like Huntsville Hospital and DCH in Tuscaloosa have cut back the hours of workers in nonessential areas. Huntsville Hospital CEO David Spillers said at a briefing last week that the medical system would lose millions of dollars every month during the pandemic.

Williamson and Kelly said hospitals are doing everything they can to avoid cutting pay or laying off workers. When layoffs have been required, they said they have been in areas that would be the last to respond to COVID-19 cases and the least likely to affect a hospital’s ability to handle a surge.

“But that’s still not ideal,” Kelly said. “Let alone the fact that we need our hospitals right now to be ready in case there’s a surge of COVID-19 cases. So the last thing we want to do is just shut down operations when we might need it.”

The state’s hospitals are facing other problems, too, including shortages of personal protective equipment, Williamson said.

“I’ve got some hospitals that are telling me they have maybe a week’s worth of PPE,” Williamson said. “I’ve got a few others that are feeling that their shortages are more immediate.”

Hospitals have been trying to source PPE — including masks, gowns and gloves — from non-traditional suppliers, through donations and through the state. The Alabama Department of Public Health has secured some additional PPE, Williamson said.

The shortage is causing the prices to go up and making obtaining those essential supplies difficult.

“It is concerning how difficult it is to get,” Williamson said. “But I certainly don’t think we’re in the situation of New York.”

While the state’s largest hospitals like UAB in Birmingham, Huntsville Hospital in Huntsville, EAMC in Lee County and DCH Regional Medical Center in Tuscaloosa will likely bear the brunt of the COVID-19 patient surge, rural hospitals are not immune from it.

Many are already treating COVID-19 patients, Kelly said, and they may be needed to help alleviate the burden on the larger hospitals, Williamson said.

“When you look at how you manage surge, you start by eliminating elective procedures because you want to free up beds,” Williamson said. “But the next part of that plan is you take people who may not have COVID, who may not need the level of acute care provided in urban hospitals, and you transfer some of those patients into, say, a rural hospital.”

But that surge plan requires those rural hospitals to be there to be able to help.

“We’re just trying to hang on,” Kelly said. “You know, targeting cuts and layoffs, and conserve money as best as possible but still be ready for patients coming in. That’s the position that most hospitals are in.”

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Health

Black people are dying more often from COVID-19 in Alabama

Chip Brownlee

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Black people are being disproportionately affected by the coronavirus in Alabama, according to new data released by the Alabama Department of Public Health.

The Department of Public Health’s data shows that about 44 percent of the verified COVID-19 deaths in Alabama so far have been among black people, but black people make up only about 27 percent of the state’s population, according to the U.S. Census Bureau.

Black people also account for a disproportionately larger number of confirmed cases of the virus, the health department’s data shows. About 36.6 percent of confirmed cases in the state that have been investigated by epidemiologists have been among black people.

“You can hypothesize that they may have some of these chronic illnesses,” said Dr. Selwyn Vickers, the dean of the UAB School of Medicine. “You could also worry that they just don’t get access. They don’t get to the hospital as early, and so it’s probably multiple reasons.”

via Alabama Department of Public Health

The area of Alabama with the least access to health care, the Black Belt region, is also the area of the state with the largest black population. Many of the counties in this region of the state have no hospital.

In this area of the state, testing was slow to get off the ground initially, Alabama State Health Officer Scott Harris said in an interview last week.

“We’ve really made an effort beginning [last] week in the Wiregrass and in the Black Belt, because we were just not seeing numbers there like we expected we would see,” Harris said. Harris said the department worked to get dedicated testing sites in those Central Alabama counties.

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The health department began releasing demographic data Tuesday. It will continue releasing that data daily, it said.

The data also shows that at least 41 percent of the state’s deaths so far have been among people younger than 65 years old. About 59 percent of the deaths have been among those in the 65-plus age bracket that is most vulnerable to the virus.

Most of the state’s deaths have been among those with underlying medical conditions like chronic lung disease, cardiovascular disease or some combination of underlying conditions, the data shows.

At least 315 medical workers — about 15.7 percent of the state’s confirmed cases — have tested positive for the virus. At least 56 nursing home employees and 51 long-term care facility residents have tested positive, according to the Department of Public Health.

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Crime

Deadline extended for Alabama prison bids due to coronavirus

Eddie Burkhalter

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Gov. Kay Ivey on Tuesday announced that because of the COVID-19, she’s giving a two-week deadline extension for submission of proposals to build then lease three new prisons to the state.

Those proposals had been due by April 30 but the two developer teams – Alabama Prison Transformation Partners and CoreCivic – will have until May 14 to file their proposals, according to a press release from Ivey’s office Tuesday.

The decision to extend the proposal submission deadline came after discussions with two groups about the impacts each are experiencing because of COVID-19 social distancing guidelines, according to Ivey’s office.

“I am steadfastly committed to the strategic effort to build three new men’s correctional facilities – this ‘Alabama solution’ is a direct result of our dedication to implement actionable solutions that address long-standing challenges facing our prison system,” Ivey said in a statement. “Given the unforeseen circumstances associated with COVID-19, it is in the best interest of the state of Alabama to grant this extension so that the developer teams have adequate time to perform required due diligence and to prepare thorough and thoughtful proposals.”

Ivey’s plan to build three new prisons is part of her solution for fixing the state’s overcrowded, deadly prisons, which remain under threat of a federal lawsuit if state officials don’t address what the U.S. Department of Justice has said are violations of inmates’ Constitutional rights to protection from violence and sexual assault.

Alabama Department of Corrections Commissioner Jeff Dunn said in a statement that the spread of COVID-19 “has only further demonstrated the critical need for new correctional facilities in Alabama.”

“As we have stated before, overcrowded conditions within the Department’s dilapidated facilities create increasingly challenging circumstances to ensure inmate and staff health and safety,” Dunn said. “The developer teams expressed the need for an extension – due to work and travel restrictions implemented in the wake of this national health crisis – and we fully supported the extension.  Improved prison infrastructure, increased staffing, and stronger rehabilitation programs will allow for transformational results.”

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Public defender working to free some inmates in Birmingham jail amid COVID-19 crisis

Eddie Burkhalter

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At least six people in the Jefferson County Jail had their paroles revoked after serving time in state prisons for non-violent crimes, and as the threat of COVID-19 inside jails and prisons increases, some are working to get them out before it’s too late.

The Alabama Bureau of Pardons and Paroles told APR on Tuesday, however, that the bureau doesn’t have the authority to release those inmates.

Adam Danneman, lead attorney at the Jefferson County Public Defender’s Office, is concerned with the bureau’s assertion.

“They’re only in because of the violations filed by the Parole Board,” Danneman said of those state inmates in the Birmingham jail. “And they’ve already revoked these people.”

ADOC on March 20 announced a 30-day moratorium on taking prison transfers from county jails in an attempt to stave off a COVID-19 outbreak in state facilities.

Danneman told APR on Tuesday that his office is working to get released those who have already served time for non-violent offenses, were out on parole and who were picked back up on mostly technical violations.

“We’re lucky in Jefferson County that our judges and our DA and our sheriff’s department have all collaborated and used some common sense, proactive measures in this crisis to keep as many of our at-risk, non-violent citizens out of harm’s way as much as possible,” Danneman said.

Now he’s hoping the state’s Pardons and Paroles Board does the same, by releasing those who can safely be released before the deadly virus spreads behind the fences.

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It’s a matter of when, not if, Danneman said of the likelihood of COVID-19 cases in the Jefferson County Jail.

“I hope I’m wrong. I hope it never comes into the jail, but if it does it’s going to be bad,” Danneman said.

There’s been no positive COVID-19 case among state inmates as of Monday, according to the Alabama Department of Corrections (ADOC), but an administrative employee at one prison has tested positive for the virus.

As of Monday, 30 state inmates had been tested for the virus, but there were still seven test results pending, according to ADOC.

Criminal justice reform advocates and legal experts have been sounding the alarm for weeks over the threat of an outbreak of the virus in jails and prisons.

Older inmates and those with medical conditions are at much greater risk from serious complications and death from the novel coronavirus, health experts warn.

“The Alabama Bureau of Pardons and Paroles does not have the authority to release these offenders,” wrote Alabama Bureau of Pardons and Paroles spokesman Terry Abbott, in a response to APR on Tuesday.

Abbott said that the Parole Board has revoked parole on six of seven inmates APR inquired about, who are awaiting transport back to the Alabama Department of Corrections to serve their sentences. The seventh inmate’s case is to come before the parole board this week, Abbott said.

It was unclear Tuesday how many state inmates were serving in county jails after having their paroles revoked for technical violations. Abbott said that number would change daily and would also involve people who have already had parole revoked and are awaiting transfer to a state prison.

Nancy Aichele, 53, is among those state prisoners serving in the Birmingham jail, where she’s been since January 24. Aichele had already served more than 18 years of a life sentence for an escape charge when she was picked up on a parole violation.

Aichele was charged with escape for walking out of an ADOC facility, without injuring anyone, after being convicted and sentenced to 3 years in 1990 for forging an $80 check, according to court records. The escape charge resulted in a life sentence with the possibility of parole.

After she was released on parole, Aichele was charged with obstruction, which triggered her parole violation and returned her to serve the remainder of her life sentence.

The obstruction charge was later dropped, according to court records, but the Bureau of Pardons and Paroles Board revoked her parole regardless.

Willie Toyer, 55, is also in the Jefferson County Jail and was sentenced to life on a 1996 marijuana trafficking charge.

Toyer was paroled after serving 22 years and six months, but his parole was revoked for two subsequent drug charges in March; a possession charge and a misdemeanor charge of possessing prescription pills.

Toyer’s case is to go before the Pardons and Paroles Board this week, according to the Bureau of Pardons and Paroles.

Leo Cain, 64,  was sentenced to life in 1994 on a first-degree robbery charge from 1992. He served almost 22 years before being paroled, which was revoked after he was charged with misdemeanor obstruction for giving false information to law enforcement.

Danneman said a parole officer had told Cain that his parole wouldn’t be revoked if he pleaded to the misdemeanor obstruction charge, but after he agreed to do so he was arrested and returned to serve the rest of his time regardless.

Danneman said he’s concerned about Cain because of his age, which puts him at greater risk of death from COVID-19.

“He’s not somebody who needs to be incarcerated right now, if at all,” Danneman said.

Shannon Blackman, 54, received a life sentence for a 1996 burglary and had served 23 years before being paroled. She’s had no new criminal charges, but her parole was revoked on a technical violation for not reporting to a parole officer.

Had she been charged with burglary today under the state’s new sentencing guidelines she would likely serve no more than 18 months, Danneman said.

“She’s done 23 years on it, hasn’t committed a new offense and is still getting revoked,” Danneman said.

On Sunday a man serving in jail in New York died from COVID-19, becoming the first jail inmate in that state to die from the virus.

Michael Tyson, 53, was serving for a technical parole violation when he died from COVID-19. He had failed to report to his parole officer, according to The City.

There were more than 500 COVID-19 cases in New York city jails as of Sunday, according to the news agency. 

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