People hoping to receive benefits from North Carolina’s Work First program may soon be required to take – and pay for – a drug test before enrolling in the program.

Work First, which provides money and services to help low-income residents become employed and self-sufficient, currently uses a written screening process to check for possible drug or alcohol abuse. Now, individuals who screen as having a high indication of substance abuse may be required to take a drug test.

Senate Bill 594 would change that, requiring that every applicant or participant take a drug test, which would cost an estimated $38 each.

Those who test positive for drugs would be rejected admission to the program. Individuals who test positive for drugs would be able to reapply after one year or upon completion of a substance-abuse treatment program.

People whose tests come back negative would get reimbursed for the cost.

David Atkinson, president of the North Carolina Association of County Directors of Social Services, said his organization opposes the bill because there’s no way to fund it. He noted counties would be responsible for bearing the cost of reimbursement.

“It is a poorly conceived piece of legislation,” he said. “Right now, it’s going to fall to the counties.”

Atkinson said Work First payments are dispensed by counties using federal block grant money, which cannot be used to reimburse participants for mandatory drug tests.

The bill passed the Senate in April and has been languishing since in the House.

At a House judiciary committee meeting last week, Rep. Nathan Ramsey (R-Fairview) said it might be difficult for the low-income people the program serves to pay for a drug test in the first place.

“We’re creating a barrier for someone who’s in need of financial assistance,” he said.

A similar law in Florida that required drug testing for welfare recipients was overturned. District and federal courts said the law violated the U.S. Constitution’s Fourth Amendment protection against unreasonable searches.

The bill is still under consideration by a House judiciary subcommittee, but has not been scheduled for a hearing.

Cover image courtesy Life Mental Health, flickr creative commons

By Rose Hoban

When Johnathan Brunson was 14 years old, he was caught stealing CDs, CD players and some batteries. He was hanging out with his cousins, who both had criminal records, and he felt like he needed to fit in.

“I was known as a ‘good guy.’ They didn’t put me on a lot of things they could have,” Brunson remembers. “But I did that to show I could do something. I may not sell drugs, but I can steal a CD.”

Johnathan Brunson drove to Raleigh from Wilson to support the bill to raise the age of juvenile offenders.

“The peer pressure was incredible,” he said.

Brunson’s two cousins are now in jail, one on murder charges, one for dealing drugs. But when Brunson was caught, he had an advocate in his mother, who made him write a letter to the chief of police in his town.

“She told me, ‘You need to convince him that you’re going somewhere in your future. I’m not gonna sit there and tell him, you tell him,’” Brunson recalled. “If it wasn’t for her, I’d have gotten something on my record.”

Instead, Brunson is now a social worker who works with young men like he was. But if he had had a criminal conviction, he might not have gotten into college or grad school.

That’s why he was in Raleigh last week, to advocate for young people like he was.

Currently, North Carolina is one of only two states in the country that charges all 16- and 17-year-olds who get caught committing a crime in the adult system, and that record stays with them for the rest of their lives – impeding their progress when they attempt to apply for student loans, jobs, even the military.

But a bill making its way through the House attempts to “raise the age” for juveniles to be charged in the adult system. Instead of being charged, tried and convicted in the adult system, they would stay in the juvenile system and have their records sealed when they reach majority.

Tough on crime, smart on crime

Currently, when a 16- or 17-year-old appears in a courtroom, judges do have some discretion about their fates. Judge Marcia Morey, chief district court judge in Durham, told a House judiciary committee last week that she sees a variety of kids.

Morey read from one of her recent dockets:

“Vicky, 16, open-container, trespass in a public park; Boyd, 16, urinating in public; Nikita, shoplifting a $19 pair of sunglasses; David, simple possession of marijuana …”

She also had cases of resisting an officer, disorderly conduct and stealing a pair of jeans from Belk.

A young Raise the Age supporter stands in the gallery of the N.C. House of Representatives

“If it’s a first offender, I tell them community service, court costs, $430, come back and see me in six months, we’ll see if it can be dismissed,” Morey told the committee. “You think they can come up with $430? No. It’ll come out of the parents’ pocket. If not, they’ll be looking at probation.

“They’re looking at $1,000 over the next 12 months to take care of their misdemeanor charge.”

“Is that the best way to handle these first-offender, nonviolent 16- and 17-year-olds?” Morey asked, adding that the kids can end up with these offenses on their records for the remainder of their lives.

Bill sponsor Rep. Marilyn Avila (R-Raleigh) noted that not every judge is willing to work with young offenders the way Morey does, and that some district attorneys want to try every young offender as an adult.

“What we want to do is standardize that so there’s not any difference in how a child is treated in Wake County and in Buncombe County,” Avila said. “We want all of our kids operating under the same rules and the same opportunities.”

Brunson said he witnesses the discrepancy now with the youth he serves in Tarboro. He works as a social worker with young, at-risk kids, many with mental health problems.

“I saw a young white girl who was stealing cars for a long time, and she was slapped on a wrist,” Brunson said.
“And right behind her was a young black boy who was stealing, and the judge threw the book at him … and the mother was crying, and I thought, ‘Wow.’”

The numbers

Cost-benefit summary, by perspective, per annual cohort of youth aged 16 and 17, net present value in millions (2010). Vera Institute of Justice.

Avila reported that the rate of juvenile crime in the state has dropped 37 percent over the past 10 years.

“Seventy-nine percent of them are misdemeanors, 18 percent are felonies and the remainder are serious felonies,” she said. “Those are the ones we hear about.”

“Many kids who get tried and convicted as adults end up in adult facilities where there’s little treatment. What treatment there is is not age appropriate,” Avila said. “But with the juvenile system, the treatment is age appropriate.”

But lobbyists from the N.C. Sheriffs’ Association and the N.C. Association of Police Chiefs expressed opposition to the bill because of the cost of caring for young offenders.

“We respectfully ask that the resources be provided to implement change in policy,” said Fred Baggett, legislative counsel for the police chiefs.

He said if lawmakers change the law, they need to provide money for programs, people and facilities to deal with a new influx of young people into the juvenile-justice system.

Avila reminded the committee that, in the long run, changing the age would save the state money, noting that studies have shown that kids remanded to the juvenile system are less likely to re-offend than young people who end up in the adult system.

An outside consultant, the Vera Institute of Justice, was hired in 2010 to do a cost-benefit analysis of raising the age of adult offense. Vera found at the time that, “The plan to raise the age of juvenile jurisdiction in North Carolina will cost taxpayers $70.9 million a year and that this annually reoccurring investment will generate $123.1 million in reoccurring benefits to youth, victims, and taxpayers over the long term.”

The consultant also estimated that treatment in a juvenile center is about $181.90 per day, or about $66,000 per year.

According to the state Department of Public Safety, it costs an average of $27,747 to house an adult prisoner for a year.

Avila said other states that have raised the age have ended up saving more money than they expected.

“Connecticut helped us understand what happens, in particular,” Avila said. “They raised the age for misdemeanor and felony, one year at a time. It wasn’t as expensive as they thought, and the problems they anticipated didn’t show up.”

Multiple studies

“This issue has been studied numerous times,” said Brandy Bynum of Action for Children North Carolina.

She told the committee that the bill had been studied in 2006 by the Senate’s policy advisory committee and by the Governor’s Crime Commission in 2007; that between 2009 and 2011, the Youth Accountability Task force met for 18 months and recommended raising the age; and that last year, a legislative committee recommended that North Carolina raise the age, at least for misdemeanants.

A young person from another state with misdemeanors can come to North Carolina and apply to one of our universities or for a job, Bynum said, without those crimes being on their permanent records, because in other states they’ve been charged as juveniles and their records are sealed by the time they’re 18 years old.

“Our own young person in North Carolina would attempt to do the same thing and would be barred from higher-educational opportunities and access to employment,” she said.

Bynum described raising the age as an economic issue.

“We’re talking about thousands of young people, since 1919, who are burdened with adult criminal-justice records who are not paying taxes here in our state,” she said. “So [either] we’re creating taxpayers, or we’re creating tax burdens.”

A bill that would have raised the age made it through the House of Representatives last year but was too late to make it through the Senate before the General Assembly recessed. At that point, all the unfinished legislation died.

Bynum said she hoped the bill could make it at least through the House before the end of the long session in a few weeks. That way, it would stay alive to go through the Senate next year during the short session.

The bill now goes to an appropriations committee before it can go to the floor for a vote.

Cover image of the old Orange County Courthouse by Leslie Looper, courtesy flickr creative commons

By Holly West

North Carolina will soon choose a side in the war against the Big Gulp.

A bill being heard by the Senate Committee on Rules and Operations would protect the food industry from the kind of lawsuits in which customers blame businesses for weight gain or obesity.

The Commonsense Consumption Act (HB683) says food manufacturers, advertisers, sellers and others in the industry cannot be held liable in civil suits involving weight gain or obesity, or any health problems that come from being overweight.

The Commonsense Consumption bill would restrict the ability to sue food manufacturers and distributors over high-calorie foods they sell. Image courtesy Afroswede, flickr creative commons

Bill co-sponsor Rep. Phillip Shepard (R-Jacksonville) said the purpose of the bill is to protect businesses from frivolous lawsuits.

“We’ve seen in other states where people have gone to the extreme of filing a lawsuit because they eat too much or they smoke all their life,” he said. “I think you’re responsible and accountable for your own self.”

A national campaign

If the bill passes, North Carolina will join a long list of states that have passed similar legislation.

In the past several years, the American Legislative Exchange Council (ALEC) has pitched Commonsense Consumption acts to state legislatures from Alabama to Illinois. North Carolina’s version of the bill is almost identical to the ALEC boilerplate.

A bill of the same name was also introduced in Congress in 2005, 2007 and 2009, but never passed.

But unlike ALEC’s model legislation, North Carolina’s Commonsense Consumption Act would also ban municipal and county governments from regulating soft drink sizes.

North Carolina is also one of many states considering so-called “anti-Bloomberg bills,” a reaction to New York City Mayor Michael Bloomberg’s attempted ban on soft drinks larger than 16 ounces.

Thus far, Mississippi is the only state that has actually made such a bill into law.

Frivolous lawsuits or frivolous law?

Katie Spears, team leader for Real Food and Active Living at Youth Empowered Solutions, a statewide nonprofit organization that advocates for young people, said her organization opposes the bill.

“We feel like this is a bill that is crafted to address a problem that does not exist,” Spears said. “No one is trying to pass legislation on the size that beverages are sold.”

Spears said she fears the bill will limit the ability of local governments to combat obesity.

“It protects companies instead of people,” she said.

Todd Barlow, political affairs counsel at North Carolina Advocates for Justice, said his organization is opposed to the part of the bill that bans lawsuits against the food industry for obesity-related claims.

“It’s just not necessary,” he said. “We can’t find any evidence that an obesity lawsuit has been filed in North Carolina.”

Barlow said if a lawsuit does come up, food producers would be protected by the state’s contributory negligence law, which makes it impossible for an individual to sue for damages if they contributed in any way to the injury for which they are suing.

But Rep. Shepard said there are loopholes in the contributory negligence law that may allow some obesity lawsuits to succeed.

“This will cover it all,” Shepard said. “There won’t be any chance for anything to slide through. We certainly wanted to make sure we had the ground covered here.”

Cover image by S.Diddy, flickr creative commons

By Rose Hoban

Many people think of emergency departments as mostly treating patients with traumas or heart attacks or an out-of-control infection.

But in 2010, Judy Tintinalli, an emergency department physician at UNC Hospitals, was getting the sense that she was seeing more and more patients coming into her emergency department with mental health problems.

She started asking around and found she wasn’t the only one with this impression.

“We’d all noticed that the number of mental health diagnoses in visits are just going up in EDs,” Tintinalli said. “And this has been going on for a while.”

Source: Emergency Department Visits by Patients with Mental Health Disorders — North Carolina, 2008–2010, MMWR 62(23);469-472

So she and her colleagues from several states started work on a study to look at rates of people coming in for care with mental health issues as one of their main complaints.

Tintinalli’s intuition was on target.

In a paper published last week, she writes that while rates of mental health issues in emergency departments are up all over the country, they’re especially high in North Carolina. Patients who came to emergency departments in the state between the beginning of 2008 and the end of 2010 were twice as likely to have a mental health complaint than in the rest of the country.

Good data

According to the Centers for Disease Control and Prevention, in 2009, about 5 percent of people coming into emergency rooms had a mental health disorder. But at that time, North Carolina’s rate was almost double, according to Tintinalli’s study.

She used data that comes from almost every emergency department in the state, a system called the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT).

The system, begun as a way to catch bioterrorism or disease outbreaks before they get out of control, collects data about the diagnoses of every visitor to North Carolina’s emergency departments. NC DETECT captures more than four million emergency department visits per year. No personal data is collected, just geographic data and information about what happened during the visit.

The system collects up to 10 possible diagnoses for each patient encounter.

“And at the end of the patient encounter, you list the diagnoses the patient had,” Tintinalli said. “You prioritize based on how critical they are.

“So, say you have someone come in with cancer, and they have pneumonia, and they’re also depressed; depression is the third diagnosis. If you come in saying you want to kill yourself, then the depression will be the first diagnosis.”

By the end of 2010, 9.3 percent of all ED visits had a mental health problem as one of the top complaints.

NC DETECT draws data from many sources and provides surveillance data to NC public health as well as to CDC. Diagram courtesy North Carolina Preparedness and Emergency Response Research Center

And Tintinalli found that not only were people coming in for mental health disorders, but those people with a main complaint of mental health problems were more than twice as likely to be admitted to the hospital.

No surprise

Clinical social worker Bebe Smith, who teaches at the UNC School of Social Work, said she wasn’t surprised to hear that North Carolina has had higher rates of emergency department usage among people with mental health issues.

“North Carolina’s mental health system has been in constant flux for over a decade,” Smith said.

“Sometimes people end up going to the ER when they’re truly suicidal and despairing and overwhelmed by stress. You know, if there are psychosocial stressors like losing a job, you don’t want to go on, you start drinking, get suicidal,” Smith said.

She said it’s called being “in crisis,” and it looks slightly different for each patient.

Tintinalli’s data showed that close to two-thirds of people coming in with mental health problems were complaining of stress, anxiety or depression.

“We let people go into crisis,” said Vicki Smith, head of Disability Rights North Carolina, who pointed to the lack of community-based services for people with mental health problems.

“We are not providing people with mental health needs the services they need to keep them out of crisis,” she said. “We allow them to go into crisis and they end up in the ED, sometimes via police cars.”

“If numbers are going up, we need to look and ask if we have adequate resources to really deal with these problems statewide,” Tintinalli said.

Vicki Smith said that’s exactly the problem.

“We can keep people out of EDs, and there are a lot of evidence-based practices to do that,” she said. “But we haven’t provided the resources.”

Severe and persistent

A lot of providers of care for people with severe and persistent mental illness, like schizophrenia or bipolar disorder, have gone out of business, Bebe Smith said. And when that happens, patients lose their continuity of care.

“That’s something important for them,” she said, “and it’s something we’ve lost.”

She also said that the state has shifted away from continuous provision of care for these people – who often are disabled enough to have Medicaid –into episodic care, as a way to save dollars.

“So people might have been in treatment for a while, they do better and then we discharge them,” Bebe Smith said.

She said many outpatient clinics have pushed providers into seeing more patients for shorter visits as a way of getting productivity – and revenues – up.

Then if patients start to do poorly, they get lost.

“So if someone misses the appointment, they don’t have time to check in on that person. But the people who are doing more poorly are the ones who need outreach,” Smith said. “The way they’ve pushed productivity levels on therapeutic workers – that’s another place where you lose the continuity that’s key in keeping people from crisis.”

So, she said, many end up in the facility of last resort – emergency departments.

It’s been a productive legislative session for those who advocate for safer interactions between someone who has used drugs and law-enforcement officers.

The state Senate unanimously passed a bill on Wednesday that aims to protect officers from being stuck by a syringe during an arrest. The bill was passed by the House of Representatives last month and now must receive Gov. Pat McCrory’s approval before becoming law.

If enacted, the law would protect a person who alerts an officer of the presence of a hypodermic needle or other sharp object prior to a search. That person would not be charged for possession of the object, even if it’s drug paraphernalia.

Used needles have more crevices for blood and viruses to adhere to, and can transmit disease. Image courtesy of NCHRC.

This was the second bill lobbied for by the N.C. Harm Reduction Coalition that’s been passed this session. In May, McCrory signed into law the Good Samaritan/Naloxone Access bill, the objective of which is to reduce drug-overdose fatalities.

The law provides limited immunity from prosecution for certain drug-related offenses for those who fear they may be overdosing and anyone who seeks medical assistance for someone else they believe to be overdosing.

The law also provides immunity from civil or criminal liability for anyone who prescribes, dispenses or distributes a drug called naloxone. Administered with an inhaler, naloxone reverses the effects of opiates and helps restore normal breathing.

According to the Harm Reduction Coalition, more than 1,100 people in North Carolina died of a drug overdose last year, most from prescription drugs, including opioid painkillers such as OxyContin, Vicodin and morphine.

Drug poisoning has now surpassed car accidents as the leading cause of accidental death in the U.S.

Why successful?

Tessie Castillo, the Harm Reduction Coalition’s communications and advocacy coordinator, attributes success in passing these bills to building strong coalitions, including law enforcement, families affected by drug overdose or drug-related imprisonment and the medical and public-health communities.

“Also, I think we found good sponsors in the legislature,” she said.

“For the Good Samaritan bill,” Castillo said, “we found them through the Child Fatality Task Force. All the legislators there are interested in reducing child mortality, and this was the only bill that will reduce child mortality for teenagers.

Senators Stan Bingham (R-Denton) and Austin Allran (R-Hickory), both members of the Child Fatality Task Force, were co-sponsors of the bill.

(The biennial budget now being finalized by the House of Representatives originally proposed abolishing the Child Fatality Task Force, but Republican leaders said yesterday they’ll discuss its future in committee.)

In lobbying for the syringe-decriminalization bill, the Harm Reduction Coalition approached legislators with law-enforcement backgrounds, presenting the bill as a means of reducing the incidence of exposure to blood-borne diseases such as HIV and hepatitis C.

“We went to them and said, ‘We train law enforcement, needlesticks are a huge problem, we have this survey that North Carolina law enforcement really wants some kind of syringe decriminalization,’ and we were able to get those legislators on board.”

Two sponsors of the bill, Rep. John Faircloth (R-High Point) and Rep. Allen McNeill (R-Asheboro), are former law-enforcement officers, and the N.C. Sheriffs’ Association supported the bill.

The coalition reports that in states in which syringes have been decriminalized, needlesticks have been reduced by as much as two-thirds.

The coalition will now monitor how effective the law is in protecting law enforcement from needlesticks and consider taking it a step further next year, perhaps to include additional paraphernalia.

Castillo said they’ll also look at advocating for an expansion of the overdose-prevention law, to include broader immunity.

The coalition is now advocating to keep state-operated alcohol and drug-abuse treatment centers open. The Senate’s budget proposes closing them, allocating some of the money saved to community-based and residential treatment services.

“Drug-abuse treatment is something that’s obviously really integral to overdose prevention,” Castillo said.

The coalition originally supported a more comprehensive syringe bill, and wasn’t optimistic of getting it passed. But after talking with legislators, they made the compromises necessary to see a bipartisan bill through.

“You’ve got to go step by step in North Carolina,” Castillo said, “and that’s what we’re doing.”

By Rose Hoban

Next to Medicaid, one of the most complicated parts of the Health and Human Services budget is the section that deals with early-childhood education. The Senate and House take quite different approaches to the area, with adjustments to different parts that, on the surface, don’t look that different. However, they are quite disparate.

According to Michele Rivest, head of the North Carolina Child Care Coalition, there are three different parts of the budget to pay attention to.

NC Pre-K, which was known as More at Four until mid-2011, is an early-childhood education program aimed at 4-year-olds. Rivest said the program is mostly aimed at economically and developmentally disadvantaged kids.

Rivest said kids attend the program for only part of the day and it’s “very prescribed” in terms of standards and licensure. The programs can be housed at a variety of locations including public schools that have extra rooms, free-standing centers or churches, but no religious instruction is permitted during the day.

North Carolina’s program has been on the receiving end of multiple national awards for quality.

Smart Start, according to Rivest, is the infrastructure of North Carolina’s early-childhood education system, organized through local Partnership for Children organizations that serve all 100 counties.

Based on the number of young children in each county, each partnership gets a certain allocation of funds.

“Smart Start helps them develop the programs and services to strengthen the local early-childhood education system in their communities,” Rivest said.

The program serves children from 0-5 years of age.

“By law, they have to put some funding into child-care subsidies; they have to put some money into improving the quality of early-childhood education,” she said.

She listed teacher qualification and training, curriculum development, supports for child care and training for providers as just a few of the activities Smart Start dollars have to provide.

Smart Start can also use 30 percent of the local allocation for child-health and family-support programming; for example, educating first-time parents about their child’s learning and development.

“We’ve been able to to move child-care centers up the star system ladder, to move many of them toward 4- and 5-star ratings,” Rivest said. “So now about two-thirds of all children are in child-care centers that are defined as ‘high quality.’”

The third part of the early-childhood budget is for Child Care subsidies, a program that’s been in place since the 1960s that allows for low-income working families to have access to child care. The program serves children from 0-13 years of age.

“Without access to child-care support, these low-income families often can’t work,” Rivest said. “It’s a necessity for working families, and that makes it a necessity for employers across the state who want to hire those workers.

“It’s a significant driver for the economy,” she said. “It’s a $1.6 billion industry.”

The total budget for Child Care subsidies is about $348 million; 80 percent of that comes from the federal government, 20 percent from state government, costing North Carolina about $69.6 million.

Rivest said most parents know the Child Care programs are more than just “babysitting.”

“We have teachers with Pre-K licenses working in child care and limited classroom sizes, and we require educational outcomes, a lot of the same things for any early-childhood education program,” she said.

RIvest said she’s concerned about some of the transfers made, in particular in the Senate budget.

“What worries me is that the Senate, in shifting money from Pre-K over to Child Care subsidies, or moving money from Smart Start to Child Care subsidies, makes it sound like it’s apples to apples, but it’s not,” she said.

Rivest said in the two decades since the beginning of Smart Start and the local Partnerships for Children, the program has become recognized as one of the nation’s premier early-childhood education systems.

“The Senate would just destroy that because it would be dismantling Smart Start. You cut any agencies by 42 percent, you’d have a hard time surviving, right?” Rivest asked.

“It’s a deep blow,” she said.

Cover photo courtesy dadblunders, flickr creative commons

By Rose Hoban

Though members of the House of Representatives argued over this year’s state budget for more than seven hours Wednesday afternoon – debating more than two dozen amendments – only one health care topic came up: a technical change to the way pharmacists invoice Medicaid and how they get paid by the program.

Any changes to health care in the final budget will instead end up being done behind closed doors in the conference committee with the Senate.

The two chambers differ on a number of health care issues, including dealing with funding for mental health group homes, eugenics compensation, funding for NC Pre-K and child care subsidies and how to pay for care for low-income pregnant women.

At least one hot-button health care issue was expected to be debated in the House floor Wednesday – eugenics compensation – but the chamber was mum on the subject.

The House budget allows for $10 million to compensate the victims of North Carolina’s eugenics program that ran from 1929 to 1973. Thousands of young men and women were forcibly sterilized in the cause of the “public good”; many of the victims were juvenile offenders or developmentally disabled.

In 2010, then-Gov. Bev Perdue created the North Carolina Justice for Sterilization Victims Foundation, which included a task force to review recommendations on how to address the sterilization issue (Note: NC Health News board member Phoebe Zerwick was a member of the task force).

The task force eventually recommended compensating victims who are still alive and can be located at the rate of $50,000 per person.

“A wrong was done in this state,” said House Appropriations Committee co-chair Nelson Dollar (R-Cary) earlier this week. “Unfortunately, there is no way for those living victims to receive compensation for that in the court system.

“What the provision essentially does is afford individuals who are still alive who were victims of some rather heinous liberal policies to be compensated.”

Last year, Perdue included $10.3 million in her budget to cover the costs of compensation, and the provision was supported by leaders in the House, but leaders in the Senate opposed it. The Senate’s view prevailed, although Speaker of the House Thom Tillis vowed to champion a compensation fund in this year’s budget.

“The reason eugenics didn’t come up today is because we beat that attempt back so badly in committee,” said Rep. Paul Stam (R-Apex), referring to the hours-long debate on Tuesday in the full House Appropriations Committee.

An amendment offered during Tuesday’s committee meeting by Rep. Larry Pittman (R-Concord) would have stripped $10 million for eugenics compensation out of the budget bill.

But many Republicans on the committee spoke movingly in favor of providing compensation to eugenics victims, and the amendment failed by a vote of 64 to 22.

“They thought they were going to get about 40, 45 votes,” said Stam, who supports compensating victims. “They thought they were going to win. When they got only 20, they got discouraged. So that’s why there was no amendment today.”

Other states had eugenics programs, but North Carolina is the only state that has proposed paying compensation to victims.

Protecting children

The other missing amendment Wednesday was one to restore the long-running Child Fatality Task Force, which has been key in proposing numerous measures to protect children since it was formed in 1991.

“That was a task force that was put into place, a temporary task force at one time that had been extended over time, and it has made some good recommendations, some that we’ve accepted,” said Rep. Justin Burr (R-Albemarle) at a press conference on Monday.

Rep. Justin Burr (R-Albemarle)

But a number of things the task force recommended, he said, had been rejected by the legislature.

Burr pointed out that local child fatality teams that investigate child deaths would be kept in place under the provision, but that the legislative study and policymaking arm of the task force would be eliminated next July.

“Its just removing a layer of that process here in Raleigh, and we’ll continue to focus on those issues,” Burr said.

Early Wednesday afternoon, during the floor debate on the budget bill, an amendment to the bill written by Rep. Jim Fulghum (R-Raleigh) appeared on the electronic dashboard section of the General Assembly website. But within a few minutes, the amendment disappeared again, and did not return throughout the floor debate Wednesday.

“I think we pretty much worked out an agreement that we’re going to work to get that knocked out in the conference committee,” said Stam, a member of the task force.

He agreed the parliamentary move eliminated the spectacle of Republicans arguing with one another on the House floor about preventing child deaths.

“Those are strictly inter-Republican issues,” he said.

Incarcerated kids too often become victims of sexual violence, but the picture is improving, according to a new survey.

The U.S. Department of Justice recently released a study on juvenile facilities that sheds light on sexual abuse faced by young inmates.

According to a survey done in 2012, 9.5 percent of youths in juvenile facilities have been sexually victimized in the past year.

This is a decrease from the DOJ’s first National Survey on Youth in Custody study in 2008-09, which found that 12.6 percent of juvenile facility inmates – both boys and girls – had experienced sexual victimization.

With a 4.2 percent victimization rate, North Carolina did better than any of its neighbors.

The report attributed the change to shifting demographics and inmate attitudes.

In 2012, fewer youth were held in large facilities than when the first study was conducted, which reduces the risk of sexual victimization, as fewer assaults occur in small facilities than in large ones.

In addition, the average time juveniles were held in facilities decreased. The study shows that the risk of being victimized by staff members, who were the most common perpetrators, increased the longer a juvenile stayed at a facility.

Data: National Survey on Youth in Custody

The report also said youth surveyed in 2012 had more positive opinions of their facility and staff members, and a larger portion of participants believed all inmates were treated fairly.

The data from the survey was used to identify which states have the highest and lowest rates of sexual victimization.

Regional differences

There were four localities with no reported incidents of sexual victimization: Delaware, Massachusetts, New York and Washington, D.C.

But in general, incarcerated juveniles in the Southeast didn’t fare so well. South Carolina and Georgia are two of four states classified as “high-rate” states – those with the highest victimization rates. They have victimization rates of 18.7 percent and 15.8 percent, respectively (see table).

The study also classified specific facilities as high- or low-rate. Of the 13 facilities categorized as high-rate, four were in Georgia and two were in South Carolina. None of North Carolina’s facilities were classified as either high- or low-rate.

The sexual victimization study was part of the DOJ’s National Survey on Youth in Custody and is mandated by the Prison Rape Elimination Act, a law passed in 2003 to reduce rape in correctional facilities.

Data are retrieved through surveys carried out in juvenile facilities across the country. The surveys include a series of questions asking participants about their personal experience with sexual assault.

By Rose Hoban

Two years after North Carolina teens reported their lowest rates of smoking in decades, state lawmakers have continued to deny budget money for tobacco-prevention efforts aimed at young people.

Mecklenburg County students Hannah Douglass and Morgan Rosenhauer came to the Legislature last year to ask for sustained tobacco prevention funding.

Neither the Senate nor the House of Representatives budget has money allocated for the Tobacco. Reality. Unfiltered. teen tobacco-prevention campaign that won national awards and has been replicated in multiple states.

Two years ago, the teen tobacco-prevention campaign received $17.3 million; last year, that was slashed to about $2.7 million; this year, nothing from either chamber.

The budgets also underfund the tobacco QuitlineNC by as much as 45 percent. According to Pam Seamans, head of the N.C. Alliance for Health, the QuitlineNC costs about $1.8 million to run for a year, a reduction from the previous year’s budget of $2.7 million.

The House has allocated $1 million; the Senate, $1.4 million.

Seamans called the budget numbers “outrageous.”

“The elimination of funding for these programs is even more outrageous considering the hundreds of millions of dollars the state brings in annually” from the Master Settlement Agreement (MSA) negotiated with cigarette makers in 1999, Seamans wrote in a statement.

Students from SE Halifax High School came to ask lawmakers for sustained tobacco prevention funding last year. Here they stood in the gallery above the NC House of Representatives.

“This year the state received a payment of $211 million and the state will receive these payments for as long as the tobacco companies remain in business,” he wrote.

North Carolina has received more than $1 billion since the MSA went into effect; the original intent of the money was to compensate states for Medicaid costs incurred in paying for the care of people with tobacco-related diseases.

In the past, MSA money went to several state-operated trust funds, including 25 percent to the Health and Wellness Trust Fund that distributed the money to organizations around the state to promote health.

Two years ago, the legislature dismantled the trust fund and moved the decision about tobacco-prevention funds to the General Assembly.

According to the Centers for Disease Control and Prevention, tobacco use costs about $2.46 billion a year in health care bills in North Carolina. The CDC has repeatedly said that tobacco use is the number one preventable cause of disease.

Docs prescribe prevention

UNC family physician Adam Goldstein said that in the 2011 Youth Behavioral Risk Survey, a study done every two years, North Carolina’ youth smoking rate was at a historic low.

According to the study, 4.2 percent of middle school students had smoked in their lives, down from 9.3 percent in 2003; 15.5 percent of high school students had smoked, down from 27.3 percent in 2003.

Dr. Adam Goldstein (far left) came to the Legislature with several colleagues to advocate for tobacco prevention money in the budget. Here they present a letter supporting the funding to Rep. Nelson Dollar (R-Cary).

“You have federal money that has come in that provides a lot of advertising that’s focused on teens,” said budget writer Rep Nelson Dollar (R-Cary) in defense of the cuts. “The Quitline is still there, and obviously North Carolina, a few years ago, decided to ban smoking from most indoor venues.

“We’ve seen numbers dropping in terms of smoking out there; they’ve been heading in the right direction. So I think we’re in good shape.”

Goldstein disagreed.

“The next survey will be done this fall,” he said. “We estimate there will be a 2 percent increase from 2011.”

Goldstein said that when state tobacco programs have been cut dramatically, smoking rates have almost uniformly increased, as the tobacco industry continues to pump billions of dollars a year into advertising.

“The state gets $139 million in MSA funds,” he said. “The simple fact of the math is that putting in 1 percent, 2 percent, 3 percent [into teen tobacco-prevention efforts] is really trivial, but yet can still have an impact.”

But Dollar cited the fact that kids don’t see smoking in movies the way they used to, and that smoking is no longer permitted in restaurants nor on the grounds of schools throughout the state.

“I think what you’re seeing on the whole is that society is making it’s decision about smoking and they’re moving away from it,” Dollar said.

“We have 100,000 new sixth graders who do need to be given some form of education about the dangers of smoking,” Seamans said. “We have had legislators say to us, ‘Who doesn’t know by now that smoking’s dangerous?’ The fact of the matter is that it’s these 100,000 new 6th graders that may or may not know.”

“We have to counteract all those marketing messages that young people are susceptible to,” Seamans said.  “This is a drop in the bucket.”

By Rose Hoban

Advocates for people with HIV and AIDS are busy calling legislators this week and working the hallways at the General Assembly in an attempt to ensure sufficient funding for the AIDS Drug Assistance Program.

The newly released budget being debated this week in the House of Representatives cuts $8 million in recurring funds for both this year and next. Those cuts are similar to those asked for by Gov. Pat McCrory in his budget.

Glen Cameron.

The Senate budget approved in late May also cuts $8 million of recurring funds but allocates $6 million in one-time funding for the each of the coming two fiscal years.

“If I didn’t have [the AIDS Drug Assistance Program], I don’t know what I’d do,” said Glen Cameron, a 58-year-old AIDS patient who lives outside of Hickory. Cameron takes three drugs for HIV, a drug to relieve the nausea the drugs cause and one blood-pressure medication.

Cameron has been on ADAP for the past three years, since he lost his job and the health insurance that came with it. Even before he lost his job, he needed help paying the co-pays for his medications, which ran into the hundreds of dollars a month.

Cameron said the total cost of his medications is more than $4,000 a month.

“Buying the drugs on your own is not a possibility unless you’re a Lotto winner,” Cameron said.

Expanded eligibility

Lawmakers have said they feel comfortable cutting funds for ADAP because additional funds for the program are expected from the federal government.

“[Legislative staff] looked at the budget, and even with the $8 million cut, the funding in the ADAP account is $5 million more than it was for the current year,” said Rep. Marilyn Avila (R-Raleigh), a co-chair of the House Health and Human Services committee.

“And they’re expecting some increased funding from the Ryan White funding out of the federal government.”

Ryan White, a teenager with hemophilia who contracted HIV in the 1980s became the public face of the disease. Shortly after his death, Congress passed the Ryan White Comprehensive AIDS Resources Emergency Act shortly after his death in 1990. Photo: Wikimedia commons

The Ryan White Comprehensive AIDS Resources Emergency Act is a federal fund that helps provide doctor visits, transportation, nutrition services and case management for people with HIV and AIDS.

Lisa Hazirjian, head of the N.C. AIDS Action Network, disagrees with that assessment. She explained that the extra funds left in last year’s ADAP account were the result of foot-dragging by the state Department of Health and Human Services to expand eligibility for the program.

Several years ago, during the fiscal downturn, North Carolina had one of the longest waiting lists for ADAP in the country. That’s when Cameron came on the program.

“I was on the waiting list for a couple of months,” Cameron remembers. “I was scared for a while.”

He explained that if a patient stops taking anti-retroviral medications, the virus quickly develops resistance.

“The worst thing in the world is to miss a dose,” said Cameron, who said he’s assiduous about taking his medications. “You can’t go on and off medications like a light bulb.”

The funding shortfall was eventually resolved through reductions in eligibility.

“It created a two-tiered system, where really poor people got ADAP and everyone above 125 percent of the federal poverty level” – $14,360 for one person – “were wait-listed,” Hazirjian explained.

“They also reduced the formulary – the list of drugs available for people to use,” she said.

That gave North Carolina the most restrictive ADAP program in the country, and, even with reduced eligibility, the waiting list grew to more than 800 people in 2010.

Last summer, former-Gov. Bev Perdue’s administration agreed to re-expand eligibility to cover people with incomes under 300 percent of the federal poverty line ($34,470 for one person), with an expanded list of available medications – parameters more like those in other states.

But the newly expanded eligibility wasn’t implemented until January of this year, Hazirjian said, and that’s why there was an unspent $5 million left over in the program’s coffers.

Federal funding shaky

Federal dollars have taken a hit this year, said Carl Schmid, deputy executive director of the AIDS Institute, a public policy organization in Washington, D.C.

Map courtesy of National Association of State and Territorial AIDS Directors

“ADAP, nationwide, will get cut $47 million this year – that’s 5 percent – due to sequestration,” Schmid said. “The president wants to increase ADAP spending by $10 million next year, but he’s constrained by sequestration too.”

He said the partisan gridlock in Congress also threatens next year’s spending.

Schmid said the U.S. House of Representatives budget cuts 18.6 percent from Health and Human Services funding for next year.

“If you apply that cut across the board in HHS, it’d be over $150 million cut additionally from ADAP, on top of reductions from sequestration,” he said.

Schmid said that level of cutting would also apply to the Ryan White CARE Act. Ryan White also provides money to support state ADAP programs.

“If you apply those House cuts, [Ryan White funding] could lose more than $400 million next year,” Schmid said. “It’s very precarious.”

According to research from the National Association of State and Territorial AIDS Directors, sequestration is likely to impact between 300 and 1,000 patients in North Carolina.

Hazirjian said she knows the federal funding stream is unsure, and so she wants to know where budget staff got their numbers.

Marjorie Donaldson, a budget analyst from DHHS, came to the N.C. AIDS Action Network’s annual meeting in April, but her only response to questions was, “I don’t have a direct answer for you.”

“The dollar figures I’m not able to give you anything specific that would be helpful or that would be correct going forward,” said Donaldson. “Its an ever-changing situation depending on the federal changes and the uncertainty we have there, and the fact that enrollment and the growth of enrollment is not a constant.”

“Since the beginning of April, we’ve been asking for projections from DHHS and have gotten nothing,” Hazirjian said. “We have periodically followed up on status of information requests and there’s no information forthcoming.”

“The HIV/AIDS community has been through a lot,” Hazirjian said, “so it’s understandable that people who depend on ADAP are wary.

“It’s a big leap of faith they’re asking us to make.”

Correction: The waiting list for ADAP grew to over 800 before changes to North Carolina’s program. The article originally said the number was 250 people, but that was actually the number of people on the waiting list when it was finally cleared in 2012.