Read our Coronavirus Coverage Here

North Carolina Health News

News. Policy. Trends. North Carolina.

Donate Now

Additional Thanks

Even as vaccines temper the spread of COVID in the US, NC advocates gathered to remind lawmakers that the country remains in the middle of another pandemic. The South, including the Tar Heel state, is ground zero for new HIV cases. #nchealth #HIV #ncpol northcarolinahealthnews.org/2…

Categories

Hannah Critchfield

shows a disposable surgical facemask alongside a red HIV awareness ribbon

HIV Cases are up in NC, even as testing is down amid the pandemic

by Leave a Comment

HIV Cases are up in NC, even as testing is down amid the pandemic - North Carolina Health News

“There are a lot of other diagnoses out there waiting to happen.”

By Hannah Critchfield

Even as vaccines temper the spread of the novel coronavirus in the United States, North Carolina advocates gathered to remind lawmakers that the country remains in the middle of another pandemic.

The South is ground zero for new HIV cases within the United States, and the Tar Heel state is no exception.

“After last year, there are a lot of people out there who are probably walking around with an STI, hepatitis, or HIV who are not aware of it,” Jacquelyn Clymore, HIV, STD, and hepatitis director at the Department of Health and Human Services. She spoke during “HIV Virtually Speaks on Jones Street 2021” on Tuesday, an HIV and hepatitis advocacy day hosted by the NC AIDS Action Network (NCAAN) and the Southern AIDS Coalition.

HIV, also known as human immunodeficiency virus, has continued to spread during the pandemic in North Carolina, but significant changes may be coming to how the state attempts to provide access to people living with the virus in the near future.

Ground zero for new cases

Just over half the people who are diagnosed with HIV in the United States each year reside in the South, despite accounting for just 38 percent of the country’s overall population. 

As the southern U.S. is the fastest growing area for the virus, about 50 percent of all deaths among adults and adolescents living with HIV also occur here. While North Carolina fares better than some of its neighboring states, it still ranks 12th worst among states for the highest rates of HIV.

Black Americans are at the greatest risk, accounting for 52 percent of new diagnoses in the South in 2018, the year for which Centers for Disease Control and Prevention data is most recently available. Black southerners have higher rates of HIV than Black people in all other regions of the United States.

Chart credit: The Centers for Disease Control and Prevention

Cases up, testing down in NC

In North Carolina, efforts to combat the novel coronavirus at times subsumed HIV prevention and outreach initiatives over the last year, as many health officials were forced to shift their focus to pandemic-related work.

“A lot of our resources at the state health department, just like in the local health departments, have had to work on COVID,” Clymore said at Tuesday’s virtual event. “It didn’t mean that our HIV and STI and hepatitis work stopped, but it did mean that some things we thought we would be doing just had to be put on hold.”

When last year’s public health crisis hit, one of the state’s most important resources was people power. But public health agencies across the state had bled resources for years and many were under-resourced.

Many county health agencies shuttered their HIV testing entirely in the early months of the pandemic, and struggled to balance the tasks required of the often minuscule number of staffers — in some places, an entire local health department can have a staff of three. 

“The people who would normally be offering HIV or STI testing in local health departments were fully pulled into COVID, so those resources – those human beings – were moved to other work,” said Clymore.

Testing for sexually transmitted infections in North Carolina dropped significantly in 2020, according to Clymore. In some counties, STI and HIV testing was down by 50 percent.

Early evidence suggests that HIV infection has nevertheless increased within the state over the last year.

“Unfortunately, we’ve seen the numbers for STIs and HIV have gone up,” said Clymore. “Not a lot, but they have gone up some, even while testing has gone down. What that tells us is that there are a lot of other diagnoses out there waiting to happen. We know there has to be more HIV and STIs and hepatitis out there than is currently being diagnosed.”

Increasing access

As COVID vaccines become widely available and accessible throughout the state, advocates and health providers alike say they hope to move forward in the fight for better treatment for people living with HIV.

“At this point, we’ve said that if you’re a community-based organization funded by us for [STI] testing, it’s time to get back out there,” said Clymore. “Get on your PPE, you should be vaccinated, you should be able to do this testing now. 

“We’ve told our local health departments that if they can’t do that work because they’re still completely entrenched in COVID, please lean heavily on [these organizations] to do testing,” she added. “Because we need to get back to it.”

Even before the pandemic, a person seeking to determine if they are HIV-positive could face barriers to getting tested. Though people with HIV can now live long, healthy lives if they have access to treatment, stigma around the diagnosis remains pervasive in many communities.

A historical lack of cultural competency in the medical field, as well as a documented history of systemic racism, may lead some individuals –particularly people of color, LGBTQ community members, and those with substance use disorders – to be wary of trusting a provider with confidential information about their HIV status, or fearful of the experience they’ll have at a testing site.

“This is still part of the ongoing problem that people living with HIV experience,” said Clymore. “There’s still a lot of judgment, and unfortunately some of it is affecting people as they come to clinics and as they come to care.”

To address this problem, the state aims to have home testing kits, where a person can conduct an HIV diagnostic test themselves, approved and available by the end of June. 

Currently, only Mecklenburg County offers home testing through a direct agreement with the federal government, according to Jeffery Edwards-Knight, supervisor at the Mecklenburg County Health Department and longtime AIDS activist, who spoke at the event.

“This is another access opportunity – removing barriers, whether they be transportation barriers or cultural barriers, and putting the power back to the person,” Peggy Weil, public policy and grants coordinator at Western North Carolina AIDS Project, said about home kits during the meeting. “There’s evidence out there that once people know their status, that even if they don’t immediately engage in care, it does alter their behavior.”

DHHS is also developing a “cultural humility” training that, starting in August, will be mandatory for organizations that receive state funding for HIV testing, in hopes that it will improve the experience of people arriving for HIV testing.

“We heard loud and clear that people really wanted that addressed,” said Clymore.

Other changes ahead

The same day “HIV Virtually Speaks on Jones Street 2021” was held, lawmakers introduced a bipartisan bill in the House that would amend the state’s “Good Samaritan Law,” which is intended to provide protection from prosecution to a person who calls 911 in the event of an overdose.

“Our [current] law is actually one of the most limited in the country,” Lee Storrow, executive director of NCAAN, who helped lead the push for this legislation alongside members of the DHHS opioid overdose prevention team, said at the summit’s closing event. 

“When the Good Samaritan Law was enacted, our drug supply looked very different,” he added. “Right now the main case of drug overdose in North Carolina is fentanyl – but possession of fentanyl is not protected under our Good Samaritan Law, so it’s a real barrier for people calling 911.”

House Bill 852, proposed by Reps. Donny Lambeth (R-Winston-Salem), Gale Adcock (D-Cary) and Vernetta Alston (D-Durham), would expand those protections to people using a broader range of substances. 

Organizations like NCAAN are also advocating for a bill that would make it easier for people to access HIV prevention medication, following on the heels of states like California and Colorado. House Bill 691, sponsored by Rep. Wayne Sasser (R-District 67), would eliminate the need for a prescription to obtain PreP (pre-exposure prophylaxis) or PeP (post-exposure prophylaxis), medication that prevents infection after possible HIV exposure if taken within a few days.

“It is 100 percent designed to allow someone to walk in the door and say, ‘I need post-exposure prophylaxis,’ and the pharmacist has the capacity to administer that without a prescription,’” said Storrow.

Throughout the day, participants discussed another bill currently working its way through the legislature — one that could threaten syringe exchanges across North Carolina. Senate Bill 607 would, among other things, ban mobile exchanges, require programs to use engraved needles and force people using their services to undergo treatment.

“Obviously there’s a lot of concern about what’s been introduced in the legislature to limit what syringe service programs can do that are absolutely not friendly to people who use drugs, people who are considering recovery, people who are actively needing the work of syringe services programs,” said Clymore. “We [at DHHS] have had the opportunity to comment on those and to say why we think they aren’t going to work, why we’re concerned about them, why they are not in the best interest of the people who those bills were created to help.”

Next year, the state anticipates it will be ready to adopt an electronic portal for its North Carolina HIV Medication Assistance Program (NC HMAP), a federal and state-funded program which provides financial assistance for medications specifically used to combat HIV. Once implemented, Clymore said, case managers should be able to determine a client’s eligibility and quickly enroll them for assistance online.

DHHS hopes to release its updated “Ending the Epidemic” plan for combating HIV in North Carolina in June, according to Clymore.

Hand painted murals adorn the walls of the Orange County Courthouse in Hillsborough where juvenile court is held several times each month. Photo credit: Taylot Knopf

North Carolina courts sentence some juveniles to life behind bars. Should that change? Some legislators think so.

by Leave a Comment

North Carolina courts sentence some juveniles to life behind bars. Should that change? Some legislators think so. - North Carolina Health News

North Carolina is also the last state to charge first graders for crimes in juvenile court. A U.S. Supreme Court ruling is sending states back to examine these practices.

By Hannah Critchfield

In the spring of 2008, the Chapel Hill community was shaken by the murder of the University of North Carolina’s student body president.

Eve Carson, a 22-year-old white woman, was kidnapped at gunpoint on the early morning of March 5, and forced to withdraw money from several ATMs in the area. 

Because she had seen their faces, the pair holding her hostage decided to kill her – they took her out into a wooded neighborhood and shot her five times. When she realized she was going to die, Carson had allegedly asked them to pray with her.

The two who killed her were sentenced to life in prison without the possibility of parole. One of them, Laurence Alvin Lovette Jr., a Black 17-year-old, was a juvenile at the time he committed the crime.

“DA Jim Woodall that tried that case, he said the 17 year old in that case was the leader that led the 21 year old through these heinous crimes,” Chuck Spahos, a member of the NC Conference of District Attorneys, said during a meeting of the House Committee on Families, Children, and Aging Policy on April 20. 

The high-profile case has reemerged in the public consciousness as North Carolina lawmakers are reaching across the aisle to push for juvenile justice reform this legislative session. Two bipartisan bills aspiring to make their way to the governor’s desk aim to change the way young people are treated within the criminal justice system.

One of the bills would eliminate life without parole for youth – like Lovette – who commit their crimes while they’re still under 18.

“Juveniles do not have fully developed brains. They can commit minor crimes, and they can commit horrific crimes,” said Rep. Marcia Morey (D-Durham), a former district court judge, said at the same meeting. “I know the case of Laurence Lovette. He was in my courtroom. And there’s much of the story of his life you have not begun to hear. These are heartbreaking cases, but taking away a juvenile’s life and sentencing them to be in a cage until they die is not going to bring the victim back.

“We’re not guaranteeing any juvenile that has committed a horrible crime will be released,” said Morey. “They have an opportunity to go to a parole hearing to show what they have done since.”

The other bill would raise the age at which a child can be held criminally responsible in juvenile court — in North Carolina, children as young as six can be declared delinquent, making it the state with lowest age threshold in the country. 

Experts say the proposed bills signal a shift in how lawmakers in North Carolina are thinking about the role brain development plays in shaping a young person’s behavior and their capacity to navigate the justice system.

Beyond raising the age for adult crimes

In the wake of years of emerging research about child development, North Carolina passed the Raise the Age law in 2019, which prevented 16 and 17 year olds accused of low-level crimes from being automatically charged as adults. North Carolina was the last state in the union to make this change. Before then, youth with prior justice system involvement were unable to receive many forms of student loans, become members of the military, live in public housing, and would face barriers to applying to college because they bore the mark of an adult criminal record.

That reform didn’t change the outcome for youth convicted of felonies like Lovette’s, but the proposal, House Bill 424, filed in the House in late March, might.

In 2012, the U.S. Supreme Court ruled that mandatory sentencing of life in prison without parole for juveniles was unconstitutional. A case known as Miller v. Alabama, the justices found automatic denial of parole would be disproportionate punishment for a child, in violation of the Eighth Amendment’s prohibition on “cruel and unusual punishments.”

Given a “child’s capacity for change,” sentencing juveniles to the harshest possible penalty should be uncommon, the majority ruled, with life without parole designated only for “the rare juvenile offender whose crime reflects irreparable corruption.”

“The Supreme Court did not outline how to make that determination, resulting in many long and expensive appeals,” said Rep. John Fairchild (R-High Point), in the April 20 hearing. The Miller ruling created a backlog of appeals for youth who were previously sentenced to automatic life without parole, with dozens still awaiting a hearing in court.

Today in North Carolina, a judge must determine if a child should receive life without the possibility of parole “as soon as is practicable” after their sentencing. A juvenile will be denied parole if a judge believes they are incapable of redemption in the future, a legal term known as “permanently incorrigible.”

HB 424, sponsored by four Republican representatives, with Faircloth as the lead sponsor, would give youth time to demonstrate change before asking an official to make that decision. 

If passed, a person under 18 who is convicted of first-degree murder would have the opportunity to be considered for — but not necessarily granted — parole after serving 25 years behind bars. Youth convicted of all other crimes would be eligible for consideration after 15 serving years. 

“This bill would eliminate the need for those [Miller] appeals by giving child offenders meaningful opportunities to demonstrate rehabilitation before the parole committee, thereby allowing North Carolina to save an estimated $30 million or so,” said Faircloth, a former police chief.

Twenty-six other states have passed similar legislation in response to the Supreme Court decision.

Opponents of the bill say the current system of evaluating a youth’s eligibility for parole at the time of conviction works. In arguments, they emphasize particularly egregious crimes – such as Lovette’s – committed by juveniles.

In last month’s meeting, Spahos evoked the victims of juvenile crime and their families. 

“On behalf of the families of [victims of juvenile crime], how are you going to tell them now that those defendants should be eligible for parole after 25 years?” said Spahos, a prosecutor of financial crimes, at the judiciary meeting. 

But those who support reform say the system currently ignores the role brain development plays in behavior and a person’s capacity to change — particularly at the expense of youth of color.

“If you look at the minors that were under the age of 18 that were sentenced to life without parole in North Carolina, it’s 92 percent of juveniles of color,” said Morey. “The racial disparity and the impact is tremendous.”

Such designations are meant to be uncommon, she said, but when they occur, the punishment is almost exclusively doled out to Black and brown youth. 

Another bipartisan bill that’s moving in the Senate, SB 207, would raise the minimum age for juvenile delinquency from 6 to 10 years old. Child advocates have long argued that kids this young lack the capacity to comprehend court proceedings and make informed decisions. 

Both reforms are supported by Gov. Roy Cooper’s Task Force on Racial Equity in Criminal Justice, according to its most recent recommendations.

Brain plasticity 

Today, neurological research shows that young people’s brains are still developing well into their early twenties — particularly when it comes to decision-making and assessing risk in emotionally charged situations.

“They just process information differently than adults,” said Dr. Cindy Cottle, a forensic clinical psychologist who advises on juvenile criminal cases across the state. “One example is with time-perspective – they’re short term-thinkers. If it’s an uncomfortable situation, they think, ‘Okay, what is going to get me out of this situation and make this go away quickest?’ They’re not thinking of how this is going to impact them in the long-term.”

Research performed in the past two decades informed partly by advanced brain scanning technology has shown that people with fully developed brains rely heavily on their frontal lobe, which deals with logical decision-making, when determining whether to take a specific action. Adolescents and people in their early twenties, however, tend to rely more on the part of the brain called the amygdala, which deals with processing of emotions. 

Notably, because the brain is still malleable — a term known as “plasticity” — people are never more receptive to change than in adolescence, Cottle said.

“By damning them to life without parole, it takes away any hope for improvement at a time, ironically, when the brain and the body are most primed to learn, primed to change,” she added. 

Whether some youth are “permanently incorrigible” needs more research — existing evidence does not support the phenomenon, according to Cottle.

“There’s mental health conditions and behavioral conditions that are not even diagnosed until after a person turns 18 because, by definition, we understand as health care providers and clinicians that teenagers are still changing — they’re a moving target,” she said. “With the term ‘permanently incorrigible,’ you’ve made up your mind who they are and what they’re capable of for the next 50 years. And I just don’t know anybody that’s that skilled to do that.”

With additional evidence of racial disparity in these determinations — Cottle could not recall a single case she’d evaluated in which a white juvenile received life without parole — the psychologist said she views these bills as an attempt for law to catch up to science.

“I understand that some people do have to be held in prison or detention,” said Cottle. “But to at the same time say, ‘We’ve already decided that you’re not going to change for the rest of your life,’ is a pretty powerful statement. When you look at it from a juvenile’s perspective and you’re told that you’re incorrigible at 16, then what reason on the planet would you ever have to try not to be that?”

Even though lawmakers heard the life without parole bill during the April committee hearing, no vote was taken on the measure and its legislative fate is uncertain.

The bill to raise the age for juvenile jurisdiction passed the Senate in March and has yet to be taken up by House committees. 

Some claim NC is becoming a ‘destination for child marriage.’ A bipartisan bill seeks to change that.

by Leave a Comment

Some claim NC is becoming a ‘destination for child marriage.’ A bipartisan bill seeks to change that. - North Carolina Health News

“We are essentially the place in the South that folks are coming to marry their underage girlfriends.”

By Hannah Critchfield

The couple entered Drew Reisinger’s office in Asheville after a three-hour trip across two state lines.

He was 49, and she had just turned 17. They’d traveled to North Carolina from Kentucky for the state’s more permissible marriage laws, they said. 

It was 2019, one year after the state of Kentucky had passed a law banning marriage with someone under 18 without a court order. The couple wanted Reisinger, the Buncombe County register of deeds, to issue a license for their marriage in the Tar Heel state instead.

Reisinger took the girl aside to ask her questions privately — she’d celebrated her 17th birthday less than a month before, still lived with her mother, who homeschooled her, and had no work experience. She still said she wanted to marry this man, who was her boyfriend. Reisinger quickly Googled Kentucky’s laws – as of 2018, the man’s relationship with her, if at all sexual, would have been a felony offense.

“It felt too off for me to put my stamp on — I told them that they were welcome to come back once she turned 18. I denied them a marriage license, which could have legal repercussions for me,” he said. “They just went to the next county, got their marriage license, no questions asked, and a civil magistrate in that county married them that day. They went back to the state of Kentucky a married couple.”*

New bipartisan bills seek to keep Reisinger or any of his colleagues from a similar situation. House Bill 41 and a companion, Senate Bill 35 set the minimum age for marriage in North Carolina to 18 years old.

The state currently permits minors as young as 14 to marry, tying with Alaska for the lowest legal age of marriage in the United States.

“When I picked up the general statute and I read what the age for marriage was, it was really shocking to me, because I have a 14-year-old daughter,” said Sen. Vicki Sawyer (R-Mooresville), one of the sponsors of the bill in the Senate. “I just felt like that there should be some revisiting of this idea of when and at what age a girl should be married.”

Adults marrying children

There is no state body that tracks child marriages within North Carolina, one of just six states to not publicly provide this information.This data is handled at the hyper-local level, by county register of deeds’ offices. But some evidence suggests that North Carolina may have the fourth highest number of marriages involving a minor in the country. 

The existing data do not include numbers for Wake or Mecklenburg counties, the state’s largest and most urban counties.

In August of last year, the International Center for Research on Women, in coordination with Reisinger, released a report based on data from half of the 100 local register of deeds’ offices throughout the state. Between 2000 and 2019, these county officials reported 3,949 marriage license applications involving minors.

Approximately 93 percent of these marriage requests involved an adult seeking to marry a minor –  not a union of two minors. 

“It definitely corrects the sort of hoped-for Romeo and Juliet myth, that this is just a couple of kids who didn’t want to wait,” said Lyric Thompson, senior director of policy and advocacy at ICRW. 

Of these requests, 241 involved someone who was at least 10 years older than the minor – and 26 involved someone who was at least 20 years older. 

The report and researchers involved did not provide the number of requests between an 18 year old – meaning a person who had only recently become a legal adult – and a legal minor.

Based on the findings, researchers then extrapolated, based on population size, an estimated number of marriage licenses filed in the remaining 50 counties, for an approximate total of 9,127 marriage license applications involving a child in North Carolina during this time. 

The Tar Heel state is more restrictive when it comes to minor-involved marriages than a number of other states, however, which have no age floor at all.

Creating a loophole?

Currently, children who are 16 or older need a parent’s signed consent to get married within the state. 

Kids who are 14 or 15 can marry in the event of a pregnancy – known as the  “pregnancy exception” – but must undergo court review for the marriage license to be granted. 

In these cases, a guardian ad litem is appointed to determine if the marriage is in the child’s best interest, according to state law, with the goal of trying to determine that the child has not undergone exploitation or coercion.

“It’s happening pretty much across the board, in east, west, and central North Carolina,” Thompson said. “What we see from evidence elsewhere is that there’s virtually no difference in terms of rural, urban, race, or religion — only education level is correlated with later marriage — if you don’t have alternatives, it doesn’t matter where you live.

“Pregnancy is a highly motivating factor in the United States, with norms and expectations around, ‘Well wouldn’t it make sense that she’d be better off if she were married?’” she added.

Critics of existing state law argue it creates a loophole that allows abusers to evade statutory rape charges for having sex with children while they are still too young to attain a driver’s license.

“I think there’s this hope that this problem was just going to go away,” said Reisinger. “But North Carolina has been one of the reasons it’s not going away, because we are essentially the place in the South that folks are coming to marry their underage girlfriends.”

In North Carolina, an adult having sex with a minor who is several years younger is considered a felony. But a marriage-due-to-pregnancy exception legalizes these relationships, advocates say.

Over half – 57 percent – of these marriages in existing North Carolina data involved pregnancies that resulted from a sexual relationship that could have been prosecuted as a felony under state statutory rape laws, meaning the adult was significantly older than the young teenager.

In one instance, a pregnant 15-year-old married an adult who was 29, local county data show.

Raising the age

“I think lots of people are trying to cipher through: If a 17 year old gets a 16 year old pregnant, and they want to get married, how do we make that okay, and still prevent the predators who are using North Carolina as a place to justify their predation on young girls?” said Rep. Ashton Wheeler Clemmons (D-Greensboro), one of the House bill sponsors. “I think well intentioned people can support one, and be horrified by the other.”

But Wheeler Clemmons said many people are “shocked” to learn that 14 year olds can legally get married in North Carolina. 

“When I tell people that I’m working on a bill about that, they’re like, you have to be kidding me,” she said.

Research shows teenage marriage is associated with long-term health consequences, including poverty throughout adulthood. 

These disparities disproportionately affect girls, as national and international research shows marriages between a minor and an adult often involve a female child marrying an older male.

Girls who marry as teenagers are 50 percent less likely to complete high school than their unmarried peers, according to U.S. Census data tabulations, and four times less likely to complete college in the future. Women who marry before the age of 16 and do not complete high school are about 30 percent more likely to live below the poverty line as adults, as opposed to 11 percent among women in general who do not complete high school. 

Child marriage is associated with higher rates of sexually transmitted infection, cervical cancer, divorce, unwanted pregnancy, death during childbirth and infant malnutrition. Girls who marry at age 18 or younger are additionally at greater risk for diabetes, heart attacks and strokes. They’re also almost twice as likely to develop a major depressive disorder as girls who do not marry before this age. 

‘A child marriage destination site’

In the last five years, neighboring states of Virginia, Kentucky and Georgia have all raised the age at which a person can legally marry to 18. In 2018, Tennessee adopted a new law that banned children under 17 from marrying, and forbade marriage between a 17 year old and someone four or more years their senior.

Local county registers of deeds, who review marriage license applications, say North Carolina may be becoming a child marriage destination site due to its lower age restrictions.

In Buncombe County, for example, applications for marriages that involve a minor are decreasing overall. But the percentage of those requests filed by out-of-state applicants has skyrocketed since 2015.

The percentage of underage marriage requests filed in Buncombe County that came from out-of-state applicants, as of August 2020. Chart courtesy: Drew Reisinger

“North Carolina is one of the easiest states in the country to get a marriage license, which is great for a lot of purposes, but not necessarily for child brides,” said Reisinger. “We’ve seen this massive increase from out-of-state applicants coming to Buncombe County because their state laws won’t allow them to marry their underage girlfriends.”

North Carolina has allowed people as young as 14 to marry since 2001. Before that, the state permitted children age 12 and older to marry under certain conditions.

Likelihood of passing

Sponsors of the bills acknowledge that some of its language will need to change in order to pass as law.

“Frankly, we have members in the House and the Senate whose parents were married at age 15 or 14,” said Sawyer. “So they are not really excited about the thought of absolutely eliminating marriage altogether.”

The Republican senator said bill sponsors are working on compromises in the House and Senate legislation that would focus on age differences between children seeking to get married and their partners.

“What we’re trying to do though is focus on the 90 percent of child marriage cases where a young woman is with someone who’s a lot older,” she said. “I don’t want to disallow a 16 and 17 year old from trying to make a home for their child if they get pregnant. But again, that’s a very small portion of the larger picture of children who are being married.”

With compromise language, bipartisan proponents hope one of the proposed bills will move forward next week, according to Sawyer and Clemmons. 

If passed, the law would apply immediately to pending and future marriage licenses. 

*NC Health News was able to confirm this account through review of the couple’s marriage license application, obtained by a Freedom of Information request.

North Carolina prisons reopen visits for children, extend time limits

by Leave a Comment

North Carolina prisons reopen visits for children, extend time limits - North Carolina Health News

Because of COVID restrictions, it’s been months children have been able to incarcerated relatives. Some restrictions will still apply.

By Hannah Critchfield

As the vaccine rollout continues behind bars, North Carolina state prisons are expanding opportunities for families to see incarcerated loved ones.

All young children are now permitted to visit parents or family members in prison. 

ad reminding readers to support our COVID coverage

This new policy went into effect on April 1, according to Department of Public Safety Spokesperson John Bull. Nonetheless, some incarcerated people and as well as their family members appeared to be unaware of the change prior to being contacted by North Carolina Health News.

“My grandson Will, who’s six, was with me last weekend, and he said, ‘I haven’t seen my daddy in so long,’” said Teresa Hovatter, whose son Will Hovatter Sr. is incarcerated at New Hanover Correctional Center in the eastern part of the state. At the time, she did not know Will Jr., who’s 6, might be eligible to visit.

“I said, ‘I know little Will, but we can’t help it, because of the virus. That’s why he tries to call you every day,’” she recalled.

State-run prisons without “a significant outbreak of COVID-19” have technically been open for visitations on a limited basis since October 2020. 

Even those that were open to visitors had significant restrictions. The time a person could visit their family member was limited to 30 minutes, and notably, kids under 12 couldn’t visit at all.

Carceral settings, where many people live in relatively tight quarters and social distancing  can be difficult, have long been considered “incubators” for transmission of the virus. During winter months, almost half of North Carolina’s 55 state prisons faced coronavirus outbreaks at once — leading these facilities to once again close their doors as holidays came and went.

“I would give anything if [little Will] could just go visit his daddy,” Hovatter previously told NC Health News and WFAE. “There have been a couple of times that he’s questioned if he’s still alive. And that — that’s just heartbreaking.”

Under the new policy, state prisons may also now extend visit times past 30 minutes, “at the discretion of the leadership at each prison facility,” according to Bull.

Still rolling out

Bull said he did not have an available list of prisons that have implemented a return to normal visitation times.

“I don’t know the duration of visitations at each of the 55 prisons,” he said. “They would vary.”

DPS has not yet published anything on their website announcing the change, but NC Health News is including a copy of details on the new visitation policy below.

As the world gradually reopens in the wake of the coronavirus pandemic, some limitations on visits in prisons will remain.

Visitors will still not be able to hug or touch their incarcerated loved ones, for example.

“Little Will is so anxious to see his daddy,” said Hovatter. “But if we have to go and Little Will just looks at him through the window, I think that’s gonna be very difficult for him. 

“He’s 6 years old. I would have to explain to him you can’t touch your daddy because of the virus. I just feel like little Will would cry and be very upset if he couldn’t get to him. So I have mixed feelings about it.”

Whether someone can visit with their loved one is not contingent on their vaccination status, Bull said.

“While offenders and staff continue to be vaccinated, Prisons is discussing what pandemic health and safety measures can be loosened in the weeks and months to come,” he added. “Those decisions will be based on public health guidance and will be made in due course.”

Some families are skeptical of how the updated policy will be implemented on the ground by wardens, who oversee visitations at individual prisons. 

Hovatter said she herself has not seen her son in seven months – New Hanover Correctional Center has been closed for visitations since mid-October, despite not having any current positive COVID-19 cases. 

Reopening visits at prisons without outbreaks were the “guidelines to the wardens,” according to Bull.

shows printouts from a sonogram

Sweeping legislation aims to combat Black maternal mortality

by

Sweeping legislation aims to combat Black maternal mortality - North Carolina Health News

“I want people to understand that implicit bias kills people,” one mother said.

For 35 weeks, Tomeka Isaac had a normal pregnancy. 

As a 40-year-old Black woman, she was at high risk for preeclampsia, a complication characterized by high blood pressure that can cause organ damage. But she diligently went to every doctor’s appointment, and to her relief, was told her blood pressure was fine. 

“My baby Jace was amazing to carry,” she said. “Every appointment I was fine, he was fine, and I didn’t have morning sickness my whole pregnancy.”

Then, on a Mother’s Day weekend visit to her in-laws’ house, she collapsed. 

She was rushed to a small hospital in Pineville, North Carolina. Her son had died in utero, an employee told her bluntly.

“Just like point-blank, period, kind of like, ‘I have other things to do, but here’s this,’” Isaac said. “Me and my husband, we were devastated.” 

It was only then that doctors informed her she’d developed a rare, life-threatening condition that causes bleeding, liver damage, and sometimes, loss of pregnancy. 

Isaac was told she would need to deliver her stillborn baby at another nearby hospital. But upon arrival several hours later, she was hustled into emergency surgery due to her pregnancy-related complication. It would be one of seven operations, in what became a 45-day hospital stay as doctors fought to save her life.

“They told my husband, ‘We’ve thrown everything at her but the kitchen sink, and we don’t know if she’ll survive,’” Isaac recalled. 

Isaac “coded” – meaning that doctors had to haul her back from the edge of death – not once, but three times. 

“When I got out of the hospital, I just started reeling, like how did we even get here, what happened? Everything was going so well … and then it wasn’t.”

In North Carolina, Black women and childbearing people are more than two and a half times more likely to die of pregnancy-related complications. With Isaac in support, a sweeping new bill package in the North Carolina General Assembly, collectively known as the “North Carolina Momnibus Act,” aims to combat these disproportionately high rates of maternal mortality among Black mothers planning to give birth.

Bias kills

Companion bills were proposed in both the Senate and the House in early April. The identical bills aim to address not only so-called social determinants of health that increase the risk of pregnancy-related complications among expectant Black parents but also the implicit bias in health care professionals long believed to play a role in their disparate mortality rates.

“I want people to understand that implicit bias kills people,” said Isaac.

Black women and childbearing people are three to four times as likely to die of pregnancy-related complications than white people nationally, according to the Centers for Disease Control and Prevention. These trends bear out regardless of socioeconomic status or education level—a Black person with a college degree is five times as likely to die in childbirth than a white counterpart—suggesting implicit bias in the health care system may play a role.

Isaac, who said she regularly attended all her check-ups and appointments throughout her pregnancy with Jace, had been suffering from a condition known as hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome. HELLP syndrome is considered a variant of preeclampsia, a serious pregnancy complication that Black people are 60 percent more likely to develop than white people. 

The condition can be hard to identify, particularly if protein doesn’t show up in a pregnant person’s urine. 

But Isaac said her doctors never took urine samples during her regular check-ups — a practice that, a friend later told her, is standard for pregnancy-related doctor’s visits.

“This was my first pregnancy, so I didn’t know that was a thing. I looked at my medical records, and they had not done a urine sample on me since they verified my pregnancy,” she alleged. “Even though they said that I was high-risk for preeclampsia, even though that’s standard care.”

HELLP has a 30 percent mortality rate for expecting parents, and without intervention, has a higher rate of stillbirth death than both severe preeclampsia and eclampsia.

“It’s absolutely possible Jace would be alive [had they found this earlier],” Isaac said. “Sixty percent of maternal deaths in the United States are preventable. And it’s just things like this, it’s somebody not doing what they’re supposed to do.”

Doulas can fill the gap

The new legislation would establish an evidence-based implicit bias training program for all health care professionals involved in perinatal care.

Any health practitioner with a license, registration, accreditation or certification would be required to take the training in order to renew their license and continue practicing in the state of North Carolina.

The bills would also establish a “Maternal Mortality Prevention” grant program for community organizations already working to combat maternal mortality in Black people.

The program would award five grants of anywhere between $10,000 and $50,000 annually, with special preference given to Black women-led organizations that provide resources aligned with evidence-based practices for improving maternal health outcomes – including those that connect doulas to pregnant Black community members.

“When I first heard about the high infant and maternal mortality rate for women of color in 2015, it struck a kind of a nerve,” said Cindy McMillan, an Asheville resident. “I myself had a really bad first pregnancy where I almost died, and lost my son shortly after childbirth. I actually almost died a second time with my twins. My story is, for me, traumatic, because of the things that I went through.”

Today, she works with SistasCaring4Sistas, a women-of-color-led doula collective that provides free services to pregnant Black women in western North Carolina.

“When you think about our experiences, the common denominator with all of us is we said something, and we weren’t heard [by providers],” said McMillan. “Doing this work, we understand that there’s procedures, medically, that we may not be familiar with.

“We’ve also supported white women who they give those explanations to, and they’ll break it down to the smallest denominator to make sure they understand,” she added. “And those are not the same privileges we as Black women have been given.”

Evidence suggests birth doulas may help combat some of the risk factors associated with maternal mortality. People who are supported by a doula when giving birth are significantly less likely to need a cesarean section, which Black people experience at higher rates than all other racial groups. They can also serve as an advocate, a second set of eyes, and a birthing resource.

“We all have had adverse maternal experiences,” said Wakina Norris, another doula in the collective, which works in partnership with Mountain Area Health Education Center and Mothering Asheville. “I hear other people’s stories and mine may not have ended in death, but it was traumatic and close enough.” 

“We want to be there to make sure they get the same treatment as anyone else that doctors and nurses will support, whether they have the same pregnancy conditions, whether it’s preeclampsia, whether it’s diabetes, whether it’s medical induction that needs to happen,” said McMillan. “We’re right there with them, the whole process.”

Doulas can be expensive, though, she said, and accessing a doula who can provide culturally appropriate support free of bias can be challenging. 

Community-based programs like SistasCaring4Sistas, founded in 2016, help fill in the gaps.

“When we found out what doula work was, we were like, wow, there’s really a profession out where a person can actually be there to support you, emotionally, physically, provide information-based advocacy,” McMillan said. “Our community had not had any access to it. It kind of was upsetting because it could have actually saved or supported so many other women, including ourselves”

In addition to funding community organizations, the Momnibus legislation would create a task force to study and issue recommendations for funding to address “social determinants of health,” nonclinical factors that impact health such as poverty, education, health care access and systemic racism. 

This “Social Determinants of Maternal Health Task Force” would be under the Department of Health and Human Services, and consist of state agency leaders, people with lived experience of loss of a family member due to maternal mortality, patients who have suffered maternal morbidity, maternal health workers, and leaders from community organizations that address maternal mortality with a focus on racial and ethnic disparities.

The Momnibus Act also includes provisions for funding for DHHS to study issues affecting new moms serving in the military, and the impact of pandemics on pregnant people.

“I’ve been talking to a number of my constituents that just don’t feel that they’re getting the support they need, particularly as first-time mothers during this pandemic and so we really wanted that provision to be in there as well,” said Sen. Natalie Murdock (D-Durham), one of the sponsors of the Senate bill and herself a Black woman of childbearing age.

“I’ve had more friends than I can count quite frankly that have had difficulty with childbirth, either there were issues that were ignored or weren’t taken seriously by their doctors, or they just didn’t feel that they have the support they needed,” Murdock said.

shows the washington monument at dusk, in the foreground are the reflections on water, the pool is lined by rectangular lights.

More people died than were born last year in more than half of NC’s counties

by

More people died than were born last year in more than half of NC’s counties - North Carolina Health News

Sixty-four counties had more deaths than births in 2020, largely due to the pandemic. Data in several of North Carolina’s largest counties suggests the number may be even higher.

By Hannah Critchfield

The news during 2020 was filled with tragic scenes of families visiting their senior loved ones through windows, health care professionals breaking down over the lonely deaths of patients in intensive care wards, and funerals carried out without families receiving the caresses and comfort of loved ones. 

There have been some points of hope. For one thing, the Tar Heel state still experienced more births than deaths overall last year, according to provisional resident data provided by the North Carolina Department of Health and Human Services. In total, 115,076 residents of North Carolina were born, while 87,987 community members died.

ad reminding readers to support our COVID coverage

But the numbers belie a grim reality that for the first time in a century – perhaps ever – more people died than were born in 64 of North Carolina’s 100 counties, driven by the novel coronavirus pandemic. 

The actual number may be higher. Local data suggests even more communities may have been impacted by this troubling trend.

The North Carolina data mirrors an increased rate of death at the national level. In 2020, approximately 3,358,814 resident deaths occurred in the United States, compared to 2,854,838 deaths in final data for the previous year. It’s unclear how many people were born in the country last year, as the CDC is still gathering data.

Provisional death data suggests the country’s death rate increased by 16 percent from what it was in 2019, with COVID-19 as the third leading cause of death behind heart disease and cancer, completely pushing suicide out of the top 10 causes of death. 

bar graph shows top causes of death: heart disease, cancer, unintentional injuries, chronic lower respiratory diseases, stroke, alzheimer disease, diabetes, kidney disease, influenza and pneumonia and suicide
Age-adjusted death rates for the 10 leading causes of death in 2019: United States, 2018 and 2019. Data/ graph: National Center for Health Statistics/ Centers for Disease Control and Prevention
bar graph showing causes of death: heart disease, cancer, COVID-19, unintentional injury, stroke, chronic lower respiratory diseases, alzheimers, diabetes, influenza or pneumonia, kidney disease
Provisional number of leading underlying causes of death — National Vital Statistics System, United States, 2020. Graph, data courtesy: CDC/ National Center for Health Statistics

In the United States overall, the Centers for Disease Control and Prevention has reported an excessive number of deaths last year, which the agency largely attributed to the impact of COVID-19. Provisional death data suggests the country’s death rate increased by 16 percent from what it was in 2019.

Looking local

Part of the reason for the uncertainty around each county’s death rates has to do with bookkeeping. Most North Carolina counties track death and birth information by place of occurrence – where the person was at the time of the event – rather than by the person’s place of residence. 

“How birth and death works is that you can live in a county all your life, have a house and a family there, but the county where you are born is where that birth certificate will be recorded – and wherever you die is the same way,” said Crystal Gilliard, register of deeds for Union County. “Because that’s never going to change.”

In contrast, state health departments and the CDC collect this information by county of residence –  which can be a bit more murky, county recorders who deal with death and birth records on the local level said. Existing state-level data additionally does not include people with out-of-state residency.

In Union County, among the 10 largest counties by population, 1,562 people died and just 914 people were born. In Gaston County, another top-10 jurisdiction, 2,658 people died, while 1,794 were born. On the state DHHS data, both counties are listed as having more births than deaths, however.

“We’re kind of a bedroom community to Charlotte,” explained Gilliard. “A lot of people, especially on our western side, go to Charlotte for their doctor’s appointments or to have children, but they live in Union County. If Atrium Hospital here in Union cannot accommodate a person, if they need a little bit more help than they could give them here, they would be taken to Mecklenburg County to one of their hospitals. You have a lot of that dynamic as well.”

For many rural counties with aging populations, it’s become normal to see more deaths than births in a given year, especially as the average age of the population increases. This was the case for Union County as well, but according to Gilliard, the trend significantly worsened in the last year, with a sharper uptick in deaths than usual.

“Our number of deaths does increase a little bit each year, by about 30 annually,” she said. “From 2019 to 2020, it went up by 248 people. According to the Union County Health Department, 206 of those deaths were from COVID.”

‘I don’t think it accurately reflects the strain’

Other counties experienced this excess loss of life for the first time. 

Buncombe County, a western area containing the large HCA-run Mission Hospital in Asheville, also reported more deaths than births for the first time in its recorded history. That didn’t even occur during the 1918 flu pandemic, according to the county register of deeds, Drew Reisinger.

“It took a pretty substantial event for that to happen,” Reisinger said. “In Buncombe County alone, our excess deaths were entirely made up of COVID deaths.”

The county had 4,114 people die within their jurisdiction in 2020, according to his office’s data, while 4,055 people were born. The state figures also show there were more deaths than births in Buncombe County, but report a significantly smaller number of each – with just 2,312 births and 2,671 deaths – assigning those other deaths to the decedents’ home counties.

“The CDC and public health departments break it down by county of residence, which is frustrating,” said Reisinger. “Because I see a lot of COVID deaths happen in Buncombe County, and then they get traced back to being a Florida death, or a Connecticut death.”

In addition to North Carolinians, people from Tennessee, Wisconsin, Georgia, West Virginia, Ohio and Washington died in Buncombe County last year, according to death certificates reviewed by North Carolina Health News.

The county has the largest health system in western North Carolina, meaning many in-state residents from other counties found their way to Buncombe for more complex care during the pandemic – a phenomenon that has been the case for births among people with high-risk pregnancies in years past. 

COVID-19 placed an unprecedented burden on the county, however, Reisinger said.

“When they’re complicated COVID patients, they often got sent to the regional hub that has more specialists, better heart doctors, and a bigger ICU with more beds,” he said. “Locally, Mission Hospital and our local health care providers saw a massive uptick in deaths that were instead reported back to other counties.

“I don’t think it accurately reflects the strain that we’re seeing on our local nurses and our local health systems in these metropolitan areas that have these big hospitals,” Reisinger added.

Defining someone’s place of death or birth by the place that they reside can be subjective.

A University of North Carolina student may die within Orange County, for example, but their parents may live out-of-state. Funeral directors and physicians filling out death certificates often take their cues from family members, county registrars of deeds said, who may opt to list their loved one’s place of residence as whatever they view as their more “permanent” home.

“We see different funerals draw up death certificates in different ways,” said Reisinger. “But it’s usually how the decedent’s family views it.”

Looking to 2021

Early in the pandemic, jokes about a “baby boom” as a result of sheltering in place flourished. But an influx of “corona-babies” in 2021 is unlikely. This year will likely see trends of lower births, according to early research by economists and pollsters. 

A June 2020 report from the Guttmacher Institute found that almost half of surveyed cisgender women of childbearing age changed plans to have children due to the pandemic. A third said they wanted to get pregnant later or have fewer children. A Brookings analysis conducted in December of that year, which looked at the rising unemployment rate during the pandemic, predicted 206,000 fewer births in 2021 in the U.S.

“We incorporated this into our forecast by examining the experience of the 1918 Spanish Flu,” authors Melissa S. Kearney and Phillip B. Levine wrote in the study. “Back then, every spike in the death rate attributable to the flu was associated with a dramatic reduction in births nine months later.”

The availability of safe vaccines that appear to be effective against existing COVID-19 variants will hopefully stem the rise in deaths experienced over the last year. It’s thus hard to predict if similar trends will continue in North Carolina into 2021.

State-level data for North Carolina is provisional – meaning we won’t know the true death and birth toll for last year until DHHS has finished gathering all official certificates filled out in 2020. 

This process will likely take a good deal of time, as North Carolina still relies on a paper-based death and birth registry system, one of just three states to still do so. 

[email]
[email]
[zip]
[zip]
[listGroups]
[listGroups]
[email]
[email]
[zip]
[zip]
[listGroups]
[listGroups]