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Republicans criticize Jones for voting against Andrew Brasher

Brandon Moseley

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The U.S. Senate voted Thursday to confirm Alabama’s solicitor general to the federal judiciary in Alabama’s middle district.

The nomination was long delayed because of opposition from Democrats.

When Brasher was finally confirmed, U.S. Senator Richard Shelby, R-Alabama, who championed Brasher’s nomination from start to finish, praised the decision by the Senate.

Andrew Brasher confirmed to federal bench; Marshall appoints new state solicitor general

Alabama Attorney General Steve Marshall praised Brasher. Former Alabama Attorney General and former U.S. Sen. Luther Strange, who first hired Brasher as solicitor general, also praised Brasher.

U.S. Sen. Doug Jones, D-Alabama, voted with his party and against Brasher’s nomination. Every Democrat in the U.S. Senate voted against Brasher. Republicans were quick to criticize Jones’ “no” vote.

Alabama Republican Party Chairman Terry Lathan said, “Once again Senator Jones sides with his good New York buddy Chuck Schumer against Alabama. Solicitor General Brasher has impeccable credentials, with degrees from Samford University and Harvard Law. He has served the state of Alabama with distinction. There is no rhyme or reason for Senator Jones NO vote, other than party politics. Just more reasons to return the favor and vote NO on Doug Jones in 2020.”

State Auditor Jim Zeigler has formed an exploratory campaign to look at running for Senate in 2020, challenging Jones.

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“Not only would I have voted FOR highly-qualified Alabamian Andrew Brasher, but I would have manuveured his confirmation much sooner,” Zeigler said. “Doug Jones does not represent the people of Alabama.”

Congressman Bradley Byrne, R-Montrose, has announced his candidacy for U.S. Senate.

“Alabama’s Andrew Brasher is yet another excellent choice by President Trump to the federal court, and I’m glad the Senate confirmed him today,” Byrne said. “Sadly, Doug Jones fell in line with Chuck Schumer and voted against his nomination. As your Senator, I’ll always support judges who will defend the Constitution and respect the law, instead of trying to interpret the law in a way that advances a political agenda.”

The National Republican Senate Committee commented on Twitter:

“The Senate just confirmed former AL Solicitor General Andrew Brasher to be U.S. District Judge for the Middle District of AL — the 99th Judge of the Trump [email protected] voted with the Democrats against this qualified Alabamian.”

Jones narrowly defeated former Chief Justice Roy Moore in a 2017 special election after the NRSC refused to back Moore following the sudden surfacing of allegations against Moore that he had mistreating young women while a single Etowah County deputy district attorney in the 1970s. Moore has steadfastly denied the sexual abuse allegations.

Republicans are eager to try to take the seat away from Jones, the only Democrat to win a statewide election in Alabama in the last 11 years. Lathan has said that there is a hunger for this seat by Alabama Republicans that she has never seen before.

Former Auburn football coach Tommy Tuberville has also declared he is running for the seat while State Senate President Del Marsh, R-Anniston, has announced that he will not run after exploring a possible run earlier this year.

U.S. Senator Jeff Sessions was re-elected to this seat in 2014 without any opposition, Republican or Democratic.

In January of 2017 he was confirmed as President Donald Trump’s attorney general.  Then Gov. Robert Bentley appointed Alabama Attorney General Luther Strange to fill Sessions’ vacancy. Republican primary voters preferred Moore over Strange, setting up the Moore versus Jones December 2017 special election that went to Jones.

The Republican party primary is March 3, 2018.

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Health

COVID-19 patient at EAMC becomes hospital’s first to be removed from ventilator

Eddie Burkhalter

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A COVID-19 patient at East Alabama Medical Center on Sunday became the first to improve well enough to be removed from a ventilator.

In a video posted to the Opelika hospital’s Facebook page, hospital staff line a hallway and cheer 48-year-old Tony Thornton as he is wheeled from the ICU to a regular hospital room.

Thornton, who lives in Auburn, was admitted to EAMC on March 20 and intubated, the hospital said in a statement Tuesday.

Thornton was removed from a ventilator on Sunday and was moved to a regular room Tuesday, according to the hospital.

“I am still weak, but feeling pretty good. I talked to my wife for the first time and that was wonderful,” Thornton said Tuesday, according to the hospital. “People need to follow the guidelines. This is a big deal.”

In addition to Thornton’s improvements, 29 other hospitalized COVID-19 patients have been discharged from EAMC.

As of Tuesday evening, there were 2,197 confirmed COVID-19 cases in Alabama and 64 reported deaths from the virus, according to the Alabama Department of Public Health. There have been a total of 271 COVID-19 hospitalizations statewide.

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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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