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Budgets Moving Forward

Brandon Moseley

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By Brandon Moseley
Alabama Political Reporter

On Tuesday, May 19, the 2016 fiscal year Alabama General Fund budget HR135 is expected to be on the floor of the House of Representatives.

State Representative Christopher John England (D-Tuscaloosa) wrote on Facebook, “Tuesday’s special order calendar. You will notice two things. The first thing you will notice is that the general fund budget is the first bill on the calendar. The second thing you will notice is that there are no revenue bills on the calendar.”

State Senator Bill Holtzclaw (R-Madison) wrote on his blog, “On this the 22nd Legislative day, the House finally voted the General Fund Budget out of committee – via a voice vote meaning there is no record of how committee members voted. Nonetheless, that General Fund Budget should come to a full vote of the House on Tuesday of next week. The soonest the Senate would see the budget, assuming it passes the House on Tuesday, will be when it gets a first reading in the Senate on Tuesday – the 23rd Legislative Day.” Sen. Holtzclaw said that, “At that point the General Fund Budget could be debated in the Senate Committee on Wednesday.”

On Saturday, May 16, the Alabama Political Reporter asked State Representative Matt Fridy (R-Shelby County) if the legislature will be able to get a budget passed out of this legislative session without raising taxes.

Rep. Fridy said that the budget that will be before the House on Tuesday is, “Not pretty. There are going to be cuts.” Fridy predicted that the legislature, “…will be back in special session this summer, and that is probably a good thing.”  Fridy said that the legislature needed more time to find a, “Solution without completely slashing everything.”

Rep. England wrote, “Simply put, without revenue, we will be forced to cut just about everything.”

*Medicaid: $34.2 million (cut of five percent)
*Corrections: $19.7 million (cut of five percent)
*Mental Health: $5.2 million (cut of five percent)
*Courts: $15.8 million (cut of 14 percent)
*Human Resources: $12.3 million (cut 21 percent)

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Rep. England warned, “If we don’t match federal dollars, then we will lose even more money. Our already overburdened court system will likely slow down to a halt. Without adequate funding, the prison reform bill is dead. Also, we will likely face another federal lawsuit because of the lack of adequate mental health care.”

Rep. Fridy said that there does need to be enhanced revenues, but that is not necessarily tax increases. Fridy suggested that the State may require all employers to withhold payroll taxes from every employee. Currently employees can present a certificate asking that they be exempt from payroll taxes. The employees are supposed to file at the end of the year and pay if they owe anything. “They are owing money at the end of the year they just aren’t paying them.”

Rep. Fridy said that the legislature may take away the opt-out option, “So everybody pays the income taxes that are required by law.”  Fridy said that they are also raising fees on insurance brokers and agents and the industry is fine with that.  That will generate $3.5 million.

Sen. Bill Holtzclaw wrote, “No doubt there is still much work to be done as the Governor has already announced that he would veto the budget passed by the House Committee today.”

Fridy said that legislature is also looking at a lot of cost cutting measures such as combine some of the agencies.

Governor Robert Bentley (R) is promoting a $541 million a year tax increase to address the revenue situation.

Sen. President Pro Tem Del Marsh (R-Anniston) is promoting a package of adding a state lottery, casinos at the four existing dog tracks, and a compact with the Poarch Creek Indians to allow Class III gaming at their existing gaming facilities.

An earlier plan by Speaker of the House Mike Hubbard (R-Auburn) and Rep. Steve Clouse to raise taxes by $150 million was pulled last week due to lack of support in the House. 

The Education budget has already passed the Senate and has come out of committee in the House.  With eight legislative days left in the session the House has to pass both budgets, the Senate has to pass the General Fund budget, and then both have to agree on both budgets in order to send them to the Governor…..who has vowed to veto the General Fund budget.

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Health

ADPH investigating cases in Chambers as county emerges as state’s worst hotspot

Chip Brownlee

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The Alabama Department of Public Health is investigating and performing contact-tracing in Chambers County as the number of COVID-19 cases in the county made another jump Thursday.

The number of positive confirmed cases in the county has nearly doubled in the past two days, rising from 36 on March 31 to 66 on April 2. The county has the highest number of cases per capita of any county in the state.

As of Thursday afternoon, the number of positive COVID-19 cases in Chambers County per 100,000 people rose to 198 — more than three times the number in Jefferson County, the area of the state with the most total cases at 318.

The number of cases per 100,000 people in Jefferson County — the most populous of the state’s 67 counties — sits at 48.

Dr. Karen Landers, the assistant state health officer at the Alabama Department of Public Health, said Thursday that the department is still investigating what might have contributed to such a high number of infections.

“We’re looking at that data,” Landers said. “At the moment, we do not have an indication specifically that we can discuss in terms of absolute linkage, but we are looking very closely at that data. And certainly, contact tracing is part of our review to see how those cases might be related.”

The high number of cases in East Alabama could be attributable to a higher rate of testing. East Alabama Medical Center has submitted about 1,325 tests to the state’s lab as of Wednesday, a hospital spokesperson said. It’s unclear how many tests have been performed in the state because not all commercial labs are reporting their negative tests.

“We followed up with our Health Alert Network asking that all information be input to this,” Landers said. “We know that some commercial labs report to us and some don’t.

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Asked whether the state should require commercial labs to report their negative results, Landers said, “This would be a decision for our state health officer to consider.”

Neighboring Lee County has the second-highest number of cases per 100,000 people at 55. There are 91 total cases in Lee County.

Epidemiologists at ADPH are contact-tracing all positive cases in the state. But Chambers County appears to be a particular area of concern.

The rising number of cases in East Alabama is putting increasing strain on East Alabama Medical Center, where 30 patients were hospitalized as of Wednesday and an additional dozen are hospitalized with a suspected case of the virus.

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Health

Alabama hospitals facing “dire” equipment shortages

Chip Brownlee

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Every morning the team at UAB Hospital gets a report on the number of patients who come into the hospital infected with COVID-19 and their status. Then the doctors and other health care professions on the team receive an update on the number of days they have left before their supply of personal protective equipment runs out.

“The situation is dire,” said Dr. Jeanne Marrazzo, the director of the division of infectious diseases at UAB, during a virtual town hall with Sen. Doug Jones Thursday. “It is not just masks. It’s gloves. It’s hand sanitizer. It’s gowns.”

In some of the PPE categories, the number of days left before supplies run out is in the single digits. The hospitals may get new shipments of supplies, but if the situation deteriorates, the shortages might worsen.

“I don’t want to underplay the real threat that we — just like New York City and other hospitals — could be running dangerously short on those things soon. I think it is of the utmost importance that people understand how important that situation is,” Marrazzo said.

Marrazzo also serves on Gov. Kay Ivey’s COVID-19 task force. She said businesses across the state are enlisting to take up the challenge, but the threat that Alabama’s hospitals could run out before supplies can be refilled is real.

“This is not a hypothetical scenario,” Marrazzo said. “This is real. And these are the people who are working to take care of you and your family in our communities every single day, who are being asked to be concerned, and sometimes even make decisions about who gets to use the various degrees of PPE.”

Hospitals across the state — including East Alabama Medical Center in hard-hit Lee County — have been asking for donations of masks, gowns, gloves, hand sanitizer, bleach wipes and other necessities as a nationwide shortage of these essential medical supplies continues.

The Alabama Department of Health is not currently releasing the number of patients hospitalized in the state, but an analysis by APR yesterday showed that more than 120 COVID-19 positive patients are hospitalized in ten of the state’s largest hospitals.

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The number statewide is surely higher.

Dr. Jeanne Marrazzo

At UAB alone, there are 58 patients hospitalized — about a third of them on ventilators or ICU care, Marrazzo said. At EAMC, as of Wednesday, there were 30 positive COVID-19 patients and a dozen more suspected of having the virus. Hospitals as small as the Lake Martin Community Hospital in Dadeville are treating COVID-positive patients.

“What we’re seeing is very similar to what other hospital systems are seeing,” Marrazzo said. “We are in good shape right now, and people are working tirelessly … to make sure we have the surge capacity to figure out if we do exceed the number of beds, how we deal with that.”

The number of inpatients in the state’s hospitals is currently manageable, officials have said, after elective procedures and other non-essential medical procedures were canceled to free up beds, but hospitals are still facing a national supply shortage, and the number of patients could begin spiking soon.

Estimates from the University of Washington project that Alabama has little more than two weeks to prepare for the peak of hospitalizations.

“Alabama is critically unprepared and under-resourced to weather the storm that we’re in the midst of, and it could get worse,” said Sen. Doug Jones, a Democrat from Alabama. “States are competing against one another and against FEMA for life-saving equipment. That doesn’t need to be this way. We should have done better. We can do better.”

Alabama is still waiting on 20,000 units of testing supplies and kits, Jones said. Alabama has also asked for one million N95 protective masks and 2 million surgical masks, but FEMA has said that Alabama will only receive 152,000 of the N95 masks and 362,000 of the surgical masks it has requested.

The national stockpile is “woefully inadequate,” Jones said, adding that it was disturbing that more than 5,500 masks already received from the national stockpile were rotted and expired in 2010, according to a report from the Montgomery Advertiser.

The state has requested 200 ventilators, though estimates suggest the state may need more than a thousand ventilators if the outbreak worsens. Jones said the state is going to make additional requests, but there are only 10,000 ventilators in the national stockpile and in the U.S. Department of Defense surplus. Every other state in the country is also requesting these supplies.

“I hope that they will put Alabama at the top of the list so that we can get ahead of what we know we’re going to need,” Jones said. “We need to have more.”

A lack of testing supplies in Alabama has made grasping the scale of the outbreak difficult. In Mobile, officials have had difficulty getting needed supplies to test in the region nearest to a deadly and growing outbreak in Louisiana. In Huntsville, officials had to close a drive up testing site because they were not able to get supplies.

The CEO of Huntsville Hospital called the nationwide lack of testing materials a “travesty” earlier this week.

Thousands of units of testing materials and kits are coming, Jones said, “but we need millions,” he said. “There’s an alarming lack of tests in underserved and African-American communities. There’s not enough information about when and how these communities are going to get tested.”

Jones did not place blame on the Alabama Department of Public Health but said the problem is national — and international — in scope.

“It is not because the state is not working hard. They’re working 24 hours a day and they’re trying,” Jones said. “It’s just that the tests have not been available.”

The senator also called on President Donald Trump to issue further orders under the Defense Production Act to compel companies to produce needed medical supplies.

“It is unfortunate when you’re pitting one state against the other, one hospital within a state against the other, and one country against the other,” Jones said. “So, we haven’t had that coordination out of the administration. I’m hoping that’s going to change as the Defense Production Act comes up with ventilators. I’m hoping that we will see that more with production of masks [and other PPE].”

But Jones did call on Gov. Kay Ivey to implement a shelter-in-place or stay-at-home order. He said the state should take aggressive measures to limit the spread of the virus before the situation worsens. Marrazzo echoed that call.

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Governor

Gov. Ivey OKs release of some parole violators in jails

Chip Brownlee

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Gov. Kay Ivey is allowing the release of some alleged probation and parole violators in the custody of jails across the state. She’s also issued a number of new directives to free up health care resources.

The measures are intended to slow the transmission of COVID-19 and prepare for a rise in hospitalizations.

In a new executive order, Ivey is allowing sheriffs and local officials across the state to release some inmates being held in jails on alleged probation or parole violations if those inmates have been in jail custody for more than 20 days without a parole or probation hearing.

Violators who are being held on new criminal charges or other criminal charges aren’t eligible for release, according to the order, which mainly applies to those in custody on technical violations.

If a hearing is not held within 20 days, the sheriff shall release the violator unless they are being held on other criminal charges.

“Because the conditions of jails inherently heighten the possibility of COVID-19 transmission, I find that it would promote the safety and protection of the civilian population to allow local officials to reduce the number of local inmates being held in county jails in a way that does not jeopardize public safety,” Ivey wrote in her order.

The order does not apply to inmates in state prisons.

You can read Ivey’s full order here.

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In the same modified executive order, Ivey ordered state agencies to allow for an expanded scope of practice for health care workers like nurses, nurse practitioners and nurse anesthetists. Experts fear there may not be enough health care practitioners to care for the number of patients that may require hospitalization and inpatient care.

This part of the order, intended to reduce strain on medical workers caring for COVID-19 patients, will relax but not completely eliminate the degree of supervision required for these non-M.D. health care professionals to care for patients.

As the number of COVID-19 cases in the state rises and hospitals begin to feel the strain of the outbreak, Ivey also directed state agencies to provide temporary waivers so hospitals and nursing homes can free up bed space and open new facilities if needed.

Additional new directives in Ivey’s supplemental order:

  • Allows expedited process for out-of-state pharmacists, nurses, and doctors to obtain temporary licenses to practice in Alabama
  • Expedited reinstatement of medical licenses, allowing retired doctors, and others who left the profession in good standing to return to practice
  • Pharmacy Board can expedite procedures to establish temporary pharmacies.
  • Notary publics can notarize documents remotely.
  • Government agencies can postpone unnecessary meetings or meet remotely.
  • Corporate shareholder meetings can be conducted remotely.
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Alabama Dept. of Corrections has tested 17 inmates for COVID-19

Chip Brownlee

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The Alabama Department of Corrections has tested 17 inmates in nine of the state’s prisons for the novel coronavirus. All tests so far have been negative.

Five more inmates have been tested, but their results are pending.

ADOC began publishing test data on its website Thursday. It says it will update the information twice a week.

“The Alabama Department of Corrections remains committed to maintaining transparency – without compromising security –throughout the duration of the COVID-19 outbreak, and has been working to aggregate relevant data to keep the public informed about the health and well-being of those who live and work in our facilities,” the department says.

The first batch of testing data released from the department comes as a number of advocacy groups, families, former law enforcement officials and activists have called on the state to take extraordinary steps to protect vulnerable inmates in the state’s prisons.

They say that overcrowding in the prisons makes them particularly susceptible to an outbreak of the virus.

 

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