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Tutwiler Conditions Ruled Unconstitutional by DOJ

Brandon Moseley

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By Brandon Moseley and Bill Britt
Alabama Political Reporter

On Friday, January 17 the U.S. Department of Justice announced that their investigation into the state of Alabama’s Julia Tutwiler Prison for Women found that the State of Alabama prison system has been acting in an unconstitutional manner and that management of the State’s prison system have acted with indifference toward the plight of the women that are incarcerated there.

Officials with the Alabama Department of Corrections dispute the DOJ findings.

Department of Corrections Commissioner Kim Thomas said, “We have been proactive from the beginning.  We have never down played the significant and serious nature of these allegations.  I do not, however, agree that Tutwiler is operating in a deliberately indifferent or unconstitutional manner.  We will cooperate with the Department of Justice and continue our efforts to implement changes and recommendations with the goal of improving prison conditions and avoiding potential contested litigation.”

On May 22, 2012, the Equal Justice Initiative (EJI) filed a complaint with the U.S. Justice Department alleging evidence of “frequent and severe officer-on-inmate sexual violence.”

The group’s Executive Director Bryan Stevenson has used the words “rape and sexual assault” as a description of what he believes is taking place at the Tutwiler Prison for Women in Wetumpka, Alabama.

As of May 2012 the Justice Department announced that they had opened an investigation into the allegations.

According to the 2012 EJI report “More than 20 Tutwiler employees have been transferred or terminated in the past five years for having illegal sexual contact with prisoners. From 2009 to 2011, six correctional officers were convicted for criminal sexual abuse of women prisoners.

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According to the ADOC, there are multiple ways for complaints of custodial sexual misconduct to be made, including the use of a toll free PREA hotline, or writing or talking to assigned PREA staff within each facility.

In a 2012 report by the Montgomery Advertiser, “Since 2009, six Tutwiller employees have been convicted for crimes related to sexual misconduct. Five employees were charged with one count of custodial sexual misconduct, a Class C felony defined as engaging in sexual conduct with someone under the disciplinary watch of the state.”

On Monday, March 4, 2013, the Alabama Department of Corrections received written notification from the United States Department of Justice commencing an investigation into the conditions of confinement at the Julia Tutwiler Prison for Women pursuant to the Civil Rights of Institutionalized Persons Act of 1977.

According to the Alabama Department of Corrections, in January, 2013, Department Commissioner Kim Thomas announced implementation of a formal Action Plan to improve the operations at Tutwiler. The Action Plan is based on a Technical Assistance Report provided by the DOJ’s National Institute of Corrections. In June, 2012, Thomas invited the NIC to conduct an on-site assessment of facility operations at Tutwiler and to make recommendations to improve cross-gender supervision.  Prior to receiving the NIC’s final Technical Assistance Report in November, the ADOC began universally addressing and implementing 58 specific opportunities as identified by the NIC. To date, 57 action items have been completed.

“We consider allegations of custodial sexual misconduct to be an unacceptable abuse of power,” Thomas said.  “During the last year we have worked tirelessly to implement recommendations of the DOJ’s National Institute of Corrections, a review that I requested.  Positive reforms have been put in place and those reforms will continue.”

In a 2012 report, six women who then were either currently incarcerated at Tutwiler Prison for Women or had been released recently were interviewed on the condition of anonymity.

“In all my years at Tutwiller, I have seen lots of sex but ain’t never seen anyone raped by a CIO [correctional officers],” says Monica. “I have seen a bunch of tit for tat (she laughs) but never seen nobody forced.” Monica who is serving a 20 year sentence at Tutwiller says she like many old-timers have become very familiar with the law and she has one question to ask, “If all these smart people outside have uncovered 50 cases of rape, then how come they haven’t uncovered 50 civil law suits?”

“You got to understand, most of us have been trading sex for favors all our lives, I learned my lesson at thirteen,” says Lucy, a middle-aged woman who says she has been in and out of correction facilities most of her life.  “My uncle is the one who taught me,” she said. “One Saturday, my uncle took me for a ride in his car. We went way out in the country. He had sex and I got some new high tops. That’s the way it works here too.”

Commissioner Thomas said, “This is a matter of grave concern to me.  Sexual misconduct of any kind, including custodial sexual misconduct, is not tolerated by this Department.  From the beginning of my watch, I have made it very clear to my staff that custodial sexual misconduct will not be tolerated and is an especially egregious offense to me.  We take every action possible to prevent it from happening and if it does, we undertake prompt corrective employee discipline and pursue criminal prosecution where applicable.”

One of the inmates, “Eve”, who says she is working toward a job in mental health says, “What is happening between the CIO and the inmate is consensual sex, but there is a real and inappropriate abuse of power in these exchanges.” Eve says that the ADOC has to work harder at rooting out correctional staff that commit such acts. She says there is a great need to educate woman to make better choices. “My time at Tutwiler changed me,” said Eve. “I never want to go back there and I never want to be the person I was then in their either.”

Most of the tax dollars raised by the State of Alabama are earmarked for the education trust fund. The remaining dollars go to the general fund.  In recent years the exploding costs of the expensive Alabama Medicaid program have eaten up much of the revenue that goes into the general fund, leaving little for other government functions like the prison system.  Critics of the State’s arcane “two checking accounts” budgeting system claim that it hamstrings the legislature from appropriating money to where the greatest need is.

Alabama’s prison system are the most overcrowded in the country.  Non-violent offenders have been paroled in large numbers since 2003 leaving the prisons filled with large numbers of very dangerous people.  ALDOC lacks the staffing to adequately guard the prisoners in their care and budget crises have left the system with little options.

The DOJ action opens up the possibility that a federal judge could take control of the system and force the state to both release prisoners and spend more money on the Alabama Department of Corrections.

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Health

Cases jump in Alabama nursing homes, tests still scarce, association says

Eddie Burkhalter

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Confirmed COVID-19 cases in Alabama nursing homes have jumped in recent days, and delays in getting test kits and test results is putting lives at greater risk, according to the Alabama Nursing Home Association.

As of Monday, 31 nursing homes in 17 counties had confirmed COVID-19 cases, according to a statement from Alabama Nursing Home Association President Brandon Farmer.

The last update from ANHA on March 28 noted eight confirmed cases of COVID-19 in six nursing homes across the state.

John Matson, director of communications at ANHA, told APR in a message Monday that the organization was uncertain how many individual COVID-19 cases were currently in the 31 homes.

“These reports involve residents, staff members or both at nursing homes in rural and urban locations. These nursing homes are following the reporting guidelines and implementing isolation procedures,” Farmer said in the statement. “I predict the number of nursing homes with cases will grow as more tests are administered and the results are returned. As previously stated, the delays in receiving test kits and test results are beyond our control yet places our residents and employees at great risk.”

State nursing homes have stopped visitations and early on began screening staff for symptoms of the virus and strengthening infection control measures, Farmer noted in the statement.

“They continue to practice infection control guidelines from the Centers for Disease Control and Prevention and isolate residents who test positive or are believed to have been exposed to someone who is COVID-19 positive. Like other health care providers, nursing homes need a sufficient supply of personal protective equipment (PPE). Infection control measures will only be as effective as our ability to secure PPE,” Farmer said.

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Economy

Gov. Ivey launches state guide to COVID-19 relief efforts

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Governor Kay Ivey on Monday announced the launch of altogetheralabama.org, an online resource that will serve as a hub of information for the state’s response to the coronavirus crisis.

The site becomes the state’s official guide to COVID-19 relief efforts, to help empower those impacted by the outbreak and those who want to offer support.

“We wanted to quickly create a trusted resource that centralizes information, resources and opportunities for businesses and individuals in need of support,” Governor Ivey said. “We are all in this together.”

The website is designed to be a comprehensive guide to aid in navigating all issues related to the COVID-19 response. Individuals and business owners can seek help and identify state and federal resources that can provide a lifeline in the form of low-interest loans and financial assistance.

Business owners, for example, can learn about the U.S. Small Business Administration’s Paycheck Protection Program, which launched April 3 to provide a direct incentive for them to keep their workers on the payroll. Displaced workers, meanwhile, can use the site to learn about enhanced unemployment benefits.

“It’s important for Alabama’s business owners and its workforce to take full advantage of the resources being made available through the federal government’s $2 trillion coronavirus relief package,” said Greg Canfield, secretary of the Alabama Department of Commerce. “The site is meant to expedite the process so both employers and employees can get back up on their feet as fast as possible.”

At the same time, the site will function as a pathway for Alabama’s good corporate citizens and the general public to offer support and solutions that can help spark recovery across the state. It will act as a portal for companies, non-profits and individuals to volunteer, make donations of supplies, offer an assistance program, and even post job openings.

The site was developed in partnership with Opportunity Alabama, a non-profit organization that promotes investment in the state’s designated Opportunity Zones. It was facilitated by a partnership with Alabama Power.

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“Over the last two years, Opportunity Zones have allowed us to build a network of stakeholders that care deeply about helping distressed places,” said Alex Flachsbart, Opportunity Alabama founder and CEO. “We hope this site will provide a gateway linking our network to those businesses and communities in economic distress, no matter where they are in Alabama.”

“These are challenging times,” added Governor Ivey. “We needed a place to efficiently and rapidly post and disseminate information – as soon as it’s available – for all affected parties. Thank you for your support and partnership in helping bring Alabama together.”

Any business, program or individual who would like to join ALtogether as a resource in COVID-19 response and relief can register at altogetheralabama.org/join.

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National

How Alabama is tracking COVID-19 hospitalizations

Chip Brownlee

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Alabama on Saturday started publicly reporting the number of people hospitalized because of COVID-19 on its data dashboard. As of Monday morning, 240 people have been hospitalized since March 13, according to that data.

The day before ADPH began publishing the number of cumulative hospitalizations on its dashboard, I reported that 255 people were hospitalized with a confirmed case of COVID-19, and another 586 people were hospitalized with a suspected case of the virus awaiting test results.

The number I reported Friday night, which I got from State Health Officer Scott Harris, is not the same number that ADPH began publishing on its dashboard Saturday morning. They do not align.

It might look like he gave me wrong numbers, or that I reported them out incorrectly. That’s not the case. Let me explain why.

The number of hospitalizations displayed on the Department of Public Health’s data dashboard (240) is a cumulative total of hospitalizations since March 13. That number is obtained by ADPH’s epidemiologists as they investigate each confirmed case of the virus. The epidemiologists follow up with everyone who has tested positive for the virus and determine if the person has been hospitalized.

“The way that works is you have a positive test that comes through. Our epidemiology staff contacts the patient. They ask, ‘Hey, what is your story? How old are you? What’re your symptoms? And were you in the hospital?’,” Harris told me.

The epidemiology staff also perform contact-tracing, asking those who have tested positive who they were around, who they live with, where they work and a lot more. These investigations clearly take time.

“It’s a cumulative number because we can’t call these people every single day for the next two weeks to found out who’s still in the hospital and how many cases are hospitalized at the moment,” Harris said.

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The reality is that there are only so many investigators and a ton of confirmed cases. There will inevitably be a delay in reporting the cumulative total as epidemiologists investigate each positive case.

This brings us to the numbers I reported Friday night.

That data (255 confirmed, 586 suspected) was obtained from the Alabama Incident Management System, or AIMS. It’s the same system that is activated when there is a major hurricane, tornadoes or even an ice storm. Hospitals directly update these numbers daily, sometimes more.

The differences in the way the two numbers are obtained explain why the number I reported Friday night was higher than the cumulative total now displayed on the ADPH’s dashboard (and on our dashboard). It was simply more current.

But even the numbers from the Alabama Incident Management System are not perfect. Hospitals voluntarily report that data to the Department of Public Health.

Alabama does not have a law authorizing a statewide hospital discharge database, unlike 48 other states, Harris said, which makes tracking real-time hospitalization data difficult.

“We actually had legislation that we introduced this year to do that, but it doesn’t look like it’s going to happen now because the session is gone,” Harris said.

So the Alabama Department of Public Health has to ask hospitals to voluntarily report their hospitalization data in AIMS. Most of the state’s hospitals are doing so, Harris said. But it’s still possible that some hospitals are treating COVID-19 patients who are not reflected in the AIMS data.

While the state’s public-facing data dashboard is currently showing the cumulative total obtained by epidemiology staff at ADPH, Harris said the Department of Public Health will soon display the AIMS data instead.

“The question people want to know is not how many people have been in the hospital over the past week,” Harris said. “They want to know how many people are in the hospital today.”

When that switch happens, the number may appear to jump, but it’s really just a more current dataset.

 

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Health

Behind the model that projected 5,500 deaths in Alabama — and why it changed

Chip Brownlee

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Early last week it said 7,500 would die in Alabama by August.

This modeling from the University of Washington’s Institue for Health Metrics and Evaluation has been cited by the White House’s coronavirus task force.

This modeling — that last week suggested somewhere between 100,000 and 240,000 Americans could die — spurred President Donald Trump’s decision to extend social-distancing guidelines through April and served, at least in part, as a call to action for Alabama to issue its stay-at-home order Friday.

Then it was revised downward again to 5,500. As recently as this weekend, the model projected that Alabama would have the highest per capita death rate in the country and the fourth-highest total death toll.

But by Monday morning, it was adjusted again — this time projecting fewer than 1,000 will die by August from the novel coronavirus that causes COVID-19. Instead of the highest per capita death rate in the country, Alabama is now projected to fall somewhere in the middle — 22 out of 51.

The changing numbers and the shifting projections can tell us many things but one is this: that modeling a pandemic is hard, especially when how it pans out depends heavily upon how state governments and the people adhere to social-distancing guidelines. No one knows how this will end.

I spoke with Dr. Ali Mokdad, one of the senior scientists at IHME and a former official at the Centers for Disease Control and Prevention. He helped develop the model. (We spoke before the model was revised downward for Alabama.)

IHME’s model is live. It is updated regularly. It was never meant to be interpreted as a comprehensive prediction of the future. It was intended as a planning tool to help policymakers, hospital officials and the public plan ahead. In fact, the people who made the model hope their projections at present are wrong — that they will be revised downward more.

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“By reducing the number of people who have infections by staying at home, you can help the medical system,” Mokdad told me. “And when the peak comes, that shortage that we are projecting will not be as big as we are seeing right now because social-distancing is working.”

The updated modeling shows that social-distancing is working, not that it was never possible that 5,000 or 7,000 people could have died. Had we not acted, had people not changed their behavior, had the state not implemented a stay-at-home order, that could have surely been the case.

State Health Officer Dr. Scott Harris said the model has been helpful in planning for the peak.

“I think the thing that’s been most helpful about that model is really the timelines,” Harris said in an interview with APR.

“The margin of error they have on there is tremendous,” Harris said. “I don’t necessarily think it’s incorrect, but you can almost read what you want to on there. We could have 50,000 deaths or 5,000 deaths or any number. But the timeline makes sense, seeing when we’re expected to have a surge. That was what was most useful to us.”

The shaded area indicates uncertainty in the modeling, ranging from 1 to 247 deaths per day on April 25.

A model is only as good as its inputs. Last week, IHME’s model for Alabama had little data to work off of. The state had only just begun to report deaths. And when the state changed its reporting of deaths, and the death toll spiked as a result, IHME’s model — which is primarily based on deaths per day — adjusted.

“So one day they just kind of flipped the switch, and suddenly our numbers changed dramatically in one day even though the situation on the ground was the same,” Harris said. “I am not saying they are wrong, but the timeline is most useful.”

Even though the number of deaths per day is still increasing, the state hasn’t seen a similar jump since last week. The model, as a result, has stabilized, too.

The shaded area indicates uncertainty in the modeling, ranging from 400 to 2,000 total deaths by August.

As more data becomes available, the model will adjust again. The projections could worsen if deaths begin to spike, or the projections could get better if deaths level off before the projected peak in mid-April.

“People are working tirelessly not only to make sure that we’re going to be able to handle the need for ventilators in the coming weeks but also that we have the surge capacity to figure out if we do exceed the number of beds that we have, how we can deal with that,” Dr. Jeanne Marrazzo, the director of the infectious diseases division at UAB, said last week. Marrazzo is also a member of Gov. Kay Ivey’s coronavirus task force.

There are a number of assumptions in the model, including complete adherence to social-distancing measures. If Alabamians flout the stay-at-home order that began Saturday evening, the projections could surely be wrong — the reality could be worse. The death toll could be much higher than nine hundred because Alabama remains particularly susceptible to the virus.

“When you look at Alabama, there are more people who have risk factors in Alabama and the Southeast in general,” Mokdad said. “More obesity, more high blood pressure, more diabetes and more cardiovascular disease, and more cancer there than really anywhere else.”

The modeling also assumes social-distancing will be in place through the end of the modeling period in August. If we try to return to normal earlier, then the projections could be worthless because about 97 percent of the population would still be susceptible to the disease. The virus would surge again. Until a vaccine becomes available, the virus and the threat of mass casualties could return.

“Our bodies as a species, we have never seen this virus,” Marrazzo said. “And that’s why so many people are having such a hard time handling it after getting infected.”

That threat could be mitigated by a nationwide mass testing regime, which would enable widespread contact tracing and targeted quarantines. That testing regime would have to include the large number of people who show no symptoms. We are nowhere near the capability of testing the number of people we would need for that to work.

The revision of the death toll from 5,500 down to 900 should not be taken as an all-clear. The modeling is based on the actual death toll, which could change if our behavior changes.


Below is a Q&A of our conversation. It was edited for length and clarity.

Q: Why does the modeling look so bad for Alabama?

Dr. Mokdad: It doesn’t look good, but let me explain why. We are modeling mortality. We take the death rate and model off that. We project the death rate into the future.

Then we back-calculate the number of beds, ICU beds and ventilators that are needed. Because we know from hospitals right now how many people with COVID-19 showed up at the hospital, how many were on a ventilator, how many of them needed to be in an ICU bed, how many died and how many survived. So we can do that by calculation.

The reason we are modeling mortality and not how many cases we have is because we are concerned that we are not testing everybody who needs to be tested. So the number of confirmed cases that we are releasing as a country is not totally reflective of reality. And this is not a criticism of the country; it’s just the reality. But we are reporting as positive the people who came and got tested. And we have still a shortage of tests.

Second, there are people out there who may have COVID-19 but are asymptomatic. We have studies showing that they don’t have any symptoms. We know people who were tested here in our hospital, who were positive, but they never had any symptoms. They were tested and they were found out to be positive. But they can still pass the virus, even though they don’t have any symptoms. We also know that many have mild symptoms and may not require hospitalization. Or some who have symptoms but may think it’s something else, like allergies, especially in a state like Alabama, which is beginning its allergy season.

So we decided to model mortality. We project a peak of demand — demand of the medical system — in mid-April.

The reason why Alabama would be much worse than most other places is a number of factors. When you look at Alabama, there are more people who have risk factors in Alabama and the Southeast in general. More obesity, more high blood pressure, more diabetes and more cardiovascular disease, and more cancer there than anywhere else.

So we would expect people who are high risk to use more resources because they have conditions that would make mortality higher and there will be more demand for resources.

Q: Gov. Kay Ivey just issued a stay-at-home order. A lot of people have said that came too late. How does that play into this model?

Dr. Mokdad: So in our model, we monitor all of these decisions. We know that you closed schools. We know that you closed non-essential businesses and services should be closed. But at this time, we have not added the stay-at-home order. That happened today.

It’s really too late, unfortunately. From our perspective, it should have been done much earlier. We cannot change the past, but we can change the future. So the lesson here is that these orders should have been in place earlier, but from now on, what we really need to stress for people in Alabama, is by staying home and adhering to these social distancing guidelines, you can reduce the number of deaths. The most important part for Alabama is that it could have a shortage of facilities to take care of patients.

By staying at home, you can reduce the burden on the hospital system. You can allow your physicians to have at hand the resources they need to deliver the best medical care for everybody who needs it. By reducing the number of people who have infections by staying at home, you can help the medical system and when April 17 comes, that shortage that we are projecting will not be as big as we are seeing right now because social distancing is working.

Q: Can you talk about the timeline and why this might have come too late for the peak demand?

Dr. Mokdad: I’m not saying it’s too late to do anything. The decision was made too late. It should have been done much earlier. I’m not picking on Alabama. Even in Washington, I would have liked my governor to make that call much earlier.

I and everybody in this country, we saw a pandemic unfolding in China. We saw how aggressive their measures were. We know they suffered. We saw it. So why didn’t we prepare ahead of time for it? We knew this was coming in December or January. We had January and February.

We had over a month and a half to prepare. Let’s be realistic and say a month because the first case was in Seattle. So let’s say we had a month. Why are we having this discussion now about our capacity to produce ventilators? We are the United States of America. We have the best resources. We have the best minds here. We are a resilient population. If you inform the public and give them the right information at the right time, Americans love their country and want to protect each other. So they would have stayed at home. All of us should have made this call much earlier. It’s too bad that Alabama did it on April 4th, when other states started doing it in mid-March. Even those states should have done it earlier.

Q: What should people take away from your modeling?

Dr. Mokdad: We can still make a difference here by staying at home. We have to be very careful. At this time, especially in a state like Alabama, where I worked a lot with the CDC. I worked a lot in Alabama. We know the state has underserved populations. It has many minorities and vulnerable populations. We need to be compassionate.

It’s time for all of us right now, all of us in other states, to help Alabama. Alabama should not be left alone to deal with this burden. It’s time for us to focus on Alabama. I know New York is in the media, and they deserve that, but we should still not forget Alabama. You should not be left alone to deal with this.

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