If you were looking for evidence that Republicans in Congress have no sympathy for workers facing illness or worse from the COVID-19 pandemic, look past the party’s proposal to cut unemployment benefits.
Instead, focus on the provision in its coronavirus relief bill that Senate Majority Leader Mitch McConnell (R-Ky.) calls a must-have in any bill that passes: It’s liability protection for employers whose employees get sick at work.
This proposal has received scant attention in coverage of the GOP plan. But it’s more vicious than you could possibly imagine.
Ensuring that workers and consumers can hold companies accountable for their actions is critical to establishing a safe reopening of our economy.
Celine McNicholas and Margaret Poydock, EPI
The GOP proposal would erect almost insurmountable obstacles to lawsuits by workers who become infected with the coronavirus at their workplaces.
It would absolve employers of responsibility for taking any but the most minimal steps to make their workplaces safe. It would preempt tough state workplace safety laws (not that there are very many of them).
And while shutting the courthouse door to workers, it would allow employers to sue workers for demanding safer conditions.
This is the provision that McConnell has described as his “red line” in negotiations over the next coronavirus relief bill, meaning that he intends to demand that it be incorporated in anything passed on Capitol Hill and sent to President Trump for his signature. The provision would be retroactive to last Dec. 1 and remain in effect at least until Oct. 1, 2024.
The GOP proposal would make workplaces immeasurably more hazardous for workers, and also for customers. That’s because litigation — or the threat of litigation — is one of the bulwarks of workplace safety enforcement.
Without confidence that workplaces are safe, employees will be reluctant to come to work, and customers reluctant to walk in the door.
“Ensuring that workers and consumers can hold companies accountable for their actions is critical to establishing a safe reopening of our economy,” Celine McNicholas and Margaret Poydock of the labor-associated Economic Policy Institute have observed.
The proposal would supersede such federal worker safeguards as the Occupational Safety and Health Act of 1970, the Fair Labor Standards Act of 1938, the Americans with Disabilities Act of 1990 and the Genetic Information Nondiscrimination Act of 2008, among others.
In plain English, the Republicans are proposing to eviscerate almost all workplace protections at the moment when the threat to workers’ health may be at its highest in a century. Let’s not overlook that federal enforcement of workplace safety is anything but strong to begin with. The maximum OSHA penalty is $13,494 per violation.
That’s “insufficient to serve as a deterrent,” McNicholas and Poydock say. “Companies merely factor these penalties into the cost of doing business.”
In a surfeit of irony, or perhaps cynicism, the GOP titled its measure the “Safeguarding America’s Frontline Employees To Offer Work Opportunities Required to Kickstart the Economy Act,” or the “SAFE TO WORK Act.”
The measure, which was formally introduced by Sen. John Cornyn (R-Texas), states that it’s aimed at “discouraging insubstantial lawsuits relating to COVID-19.” It doesn’t define “insubstantial,” however.
The Republican proposal is more draconian than measures in some of the nine states that have given businesses immunity from lawsuits in the COVID-19 pandemic. It reflects a long-term conservative goal of absolving businesses from responsibility for conditions in their workplaces.
The campaign has been spearheaded by the Koch-backed American Legislative Exchange Council, which has been developing a model law on the subject for state legislatures.
Like the federal proposal, the state laws generally allow lawsuits only in cases of “gross negligence or willful misconduct,” and requires that plaintiffs show the defendant’s fault by “by clear and convincing evidence.”
That’s a higher bar than the typical requirement of “preponderance” of the evidence, which has sometimes been described as a balance in which one side’s case outweighs the other by even a smidgen.
Let’s take a look at the particulars.
The bill would move all liability cases to federal court, which instantly would increase the costs for plaintiffs. But it also imposes huge obstacles to even filing a claim.
In their initial pleadings, plaintiffs would have to list “all places and persons” they had visited and all persons who visited their home during the 14 days before they suffered symptoms of COVID-19.
They would have to explain specifically why they believed that none of those persons or places were the cause of their infection. They would have to submit “proof” of the employer’s “particular state of mind.”
What requirements would employers have to meet to be immune from a lawsuit or from any enforcement action by a federal, state or local regulator? Not many.
They’d have to show that they had been “exploring options” to comply with federal employment law, or had determined that the risk of harm to public health or the health of employees could not be “reduced or eliminated by reasonably modifying policies, practices, or procedures.”
In other words, an employer could exempt itself from federal labor law by examining its “options” or deciding that maintaining a safe workplace was just too darned hard to achieve. If a business issued or posted a written policy on limiting transmission of the coronavirus, that would be enough to achieve immunity from lawsuits.
“If a business printed out a [Centers for Disease Control and Prevention] guideline and called it a policy, voila, they get a presumption they made a reasonable effort,” observes Max Kennerly, a Philadelphia plaintiffs’ attorney who examined the GOP measure in detail and posted his concerns on Twitter.
But the measure also says that a lack of a written policy can’t be held against the business in court.
The measure incorporates another item on the GOP’s wish list of litigation obstacles: a limitation on damages. It says that plaintiffs can only collect for actual damages unless they can show “willful misconduct” by the employer and that even in that case punitive damages can’t exceed actual damages.
This is a familiar stratagem aimed at making it uneconomic to bring so-called tort lawsuits. Plaintiffs’ lawyers typically work on contingency arrangements — they shoulder the costs of a lawsuit with the expectation that they’ll cover those costs, plus a profit, from a jury’s punitive award if they win.
Limiting punitive awards means that in many cases there won’t be enough money even to break even, much less earn a living. Ergo, tort lawyers will be loath to take COVID cases. For the GOP, this is mission accomplished.
The most obnoxious provision of the GOP proposal is one that shifts the liability in COVID cases from the employer to employee. This provision allows employers to sue employees or their representatives for bringing a claim for a COVID infection and offering to settle out of court.
Most specifically, the measure mentions “demand letters.” These are communications to a prospective defendant setting forth the facts of the claim, evidence assembled by the plaintiff, a reckoning of the potential damages, and a statement of how much the plaintiff would accept to make the case go away. Here’s a sample letter published by the San Francisco law firm Rouda Feder Tietjen & McGuinn.
These documents are often designed as an opening brief in a negotiation; since neither side in an injury case really wants to go to trial, they make sense. The GOP bill would make anyone offering to settle, either through a demand letter or otherwise, liable to be sued for damages if the case they’re making is “meritless.” That’s another term that’s undefined in the measure.
Unlike the limitation on damages elsewhere in the bill, by the way, the punitive damages that can be awarded to employers bringing these lawsuits aren’t capped.
The measure also gives the attorney general the right to bring his own lawsuit in such cases. As a result, Kennerly observes, Atty. Gen. William Barr would get the right “to sue unions, labor activists, lawyers, doctors — everyone involved in coronavirus claims.”
So let’s not pretend that the Republicans have the welfare or health of working Americans at heart. They may talk about the virtues of work and the need to get workers back on the job for their own health and that of the economy.
The “SAFE AT WORK Act” proves with every line that they’re lying. Democrats on Capitol Hill should draw their own red line against it, and not budge an inch.
A coffin about to be lowered at a funeral service in a cemetery.
Nobody Accurately Tracks Health Care Workers Lost to COVID-19. So She Stays Up At Night Cataloging the Dead
Anesthesiologist Claire Rezba started tracking lost health workers almost instinctively. Researchers and industry professionals say the lack of good official data on these deaths is “scandalous†and is putting lives in danger.
When police discovered the woman, she’d been dead at home for at least 12 hours, alone except for her 4-year-old daughter. The early reports said only that she was 42, a mammogram technician at a hospital southwest of Atlanta, and almost certainly a victim of COVID-19. Had her identity been withheld to protect her family’s privacy? Her employer’s reputation? Anesthesiologist Claire Rezba, scrolling through the news on her phone, was dismayed. “I felt like her sacrifice was really great and her child’s sacrifice was really great, and she was just this anonymous woman, you know? It seemed very trivializing.†For days, Rezba would click through Google, searching for a name, until in late March, the news stories finally supplied one: Diedre Wilkes. And almost without realizing it, Rezba began to keep count.
The next name on her list was world-famous, at least in medical circles: James Goodrich, a pediatric neurosurgeon in New York City, and a pioneer in the separation of twins conjoined at the head. One of his best-known successes happened in 2016 when he led a team of 40 people in a 27-hour procedure to divide the skulls and detach the brains of 13-month-old brothers. Rezba, who’d participated in two conjoined-twins cases during her residency, had been riveted by that saga. Goodrich’s death on March 30 was a gut-punch; “it just felt personal.†Clearly, the coronavirus was coming for health care professionals, from the legends like Goodrich to the ones like Wilkes who toiled out of the spotlight and, Rezba knew, would die there.
At first, seeking out their obituaries as a way to rein in her own fear. At Rezba’s hospital in Richmond, Virginia, as at health care facilities around the U.S., elective surgeries had been canceled and schedules rearranged, which meant she had long stretches of time to fret. Her husband was also a physician, an orthopedic surgeon at a different hospital. Her sister was a nurse practitioner. Bearing witness to the lives and deaths of people she didn’t know helped distract her from the dangers faced by those she loved. “It’s a way of coping with my feelings,†she acknowledged one recent afternoon. “It helps to put some of those anxieties in order.â€
On April 14, the Centers for Disease Control and Prevention published its first count of health care workers lost to COVID-19: 27 deaths. By then, Rezba’s list included many times that number — nurses, drug treatment counselors, medical assistants, orderlies, ER staff, physical therapists, EMTs. “That was upsetting,†Rezba said. “I mean, I’m, like, just one person using Google and I had already counted more than 200 people and they’re saying 27? That’s a big discrepancy.â€
Rezba’s exercise in psychological self-protection evolved into a bona fide mission. Soon she was spending a couple of hours a day scouring the internet for the recently dead; it saddened, then enraged her to see how difficult they were to find, how quickly people who gave their lives in service to others seemed to be forgotten. The more she searched, the more convinced she became that this invisibility was not an accident: “I felt like a lot of these hospitals and nursing homes were trying to hide what was happening.â€
And instead of acting as watchdogs, public health and government officials were largely silent. As she looked for data and studies, any sign that lessons were being learned from these deaths, what Rezba found instead were men and women who worked two or three jobs but had no insurance; clusters of contagion in families; so many young parents, she wanted to scream. The majority were Black or brown. Many were immigrants. None of them had to die.
The least she could do was force the government, and the public, to see them. “I feel like if they had to look at the faces, and read the stories if they realized how many there are; if they had to keep scrolling and reading, maybe they would understand.â€
It’s been clear since the beginning of the pandemic that health care workers faced unique, sometimes extreme risks from COVID-19. Five months later, the reality is worse than most Americans know. Through the end of July, nearly 120,000 doctors, nurses, and other medical personnel had contracted the virus in the U.S., the CDC reported; at least 587 had died.
Even those numbers are almost certainly “a gross underestimate,†said Kent Sepkowitz, an infectious disease specialist at Memorial Sloan Kettering Cancer Center in New York City who has studiedmedical worker deaths from HIV, tuberculosis, hepatitis and flu. Based on state data and past epidemics, Sepkowitz said he’d expect health care workers to make up 5% to 15% of all coronavirus infections in the U.S. That would put the number of workers who’ve contracted the virus at over 200,000, and maybe much higher. “At the front end of an epidemic or pandemic, no one knows what it is,†Sepkowitz said. “And so proper precautions aren’t taken. That’s what we’ve seen with COVID-19.â€
Meanwhile, the Centers for Medicareand Medicaid Servicesreport at least 767 deaths among nursing home staff, making the work “the most dangerous job in America,†a Washington Post op-ed declared. National Nurses United, a union with more than 150,000 members nationwide, has counted at least 1,289 deaths among all categories of health care professionals, including 169 nurses.
The loss of so many dedicated, deeply experienced professionals in such an urgent crisis is “unfathomable,†said Christopher Friese, a professor at the University of Michigan School of Nursing whose areas of study include health care worker injuries and illnesses. “Every worker we’ve lost this year is one less person we have to take care of our loved ones. In addition to the tragic loss of that individual, we’ve depleted our workforce unnecessarily when we had tools at our disposal†to prevent wide-scale sickness and death.
One of the most potentially powerful tools for battling COVID-19 in the medical workforce has been largely missing, he said: reliable data about infections and deaths. “We don’t really have a good understanding of where health care workers are at greatest risk,†Friese said. “We’ve had to piece it together. And the fact that we’re piecing it together in 2020 is pretty disturbing.â€
The CDC and the Department of Health and Human Services did not respond to ProPublica’s questions for this story.
Learning from the sick and dead ought to be a national priority, both to protect the workforce and to improve care in the pandemic and beyond, said Patricia Davidson, dean of the Johns Hopkins School of Nursing. “It’s critically important,†she said. “It should be done in real-time.â€
But data collection and transparency have been among the most glaring weaknesses of the U.S. pandemic response, from blind spots in the public health system’s understanding of COVID-19 in pregnancy to the sudden removal of hospital capacity data from the CDC’s website, later restored after a public outcry. The Trump administration’s sudden announcement in mid-July that it was wresting control over hospital coronavirus data from the CDC has only intensified the concerns.
“We’d be the first to agree that the CDC has been deficient†in its data gathering and deployment, said Jean Ross, a president of National Nurses United. “But it’s still the most appropriate federal agency to do this, based on clear subject-matter expertise in infectious diseases response.â€
The CDC’s basic mechanism for collecting information about health care worker infections has been the standard two-page coronavirus case report form, mostly filled out by local health departments. The form doesn’t request much detail; for example, it doesn’t ask for employers’ names. Information is coming in delayed or incomplete; the agency doesn’t know the occupational status of almost 80% of people infected.
The data about infections and deaths among nursing home staff is more robust, thanks to a rule that went into effect in April that requires facilities to report directly to the CDC. The agency told Kaiser Health News that it is also “conducting a 14-state hospital study and tapping into other infection surveillance methods†to monitor health care worker deaths.
Another federal agency, the U.S. Occupational Safety and Health Administration, investigates worker infections, and deaths on a complaint basis and has prioritized COVID-related cases about the health care industry. But it has suggested that most employers are unlikely to face any penalties and has issued only four citations related to the outbreak, to a Georgia nursing home that delayed reporting the hospitalization of six staffers and three Ohio care centers that violated respiratory protection standards. Of the more than 4,500 complaints OSHA has received about COVID-19-related working conditions in the medical industry, it has closed nearly 3,200, a ProPublica analysis found.
Data problems aren’t just a federal issue; many states have fallen short in collecting and reporting information about health care workers. Arizona, where cases have been surging, told ProPublica, “We do not currently report data by profession.†The same goes for New York state, though a report in early July hinted at just how devastating the numbers there might be: 37,500 nursing home employees, about a quarter of the state’s nursing home workforce, were infected with the coronavirus from March through early June. Other states, including Florida, Michigan and New Jersey, provide data about employees at long-term facilities but not about health care workers more broadly. “We are not collecting data on health care worker infections and/or health care worker deaths from COVID-19,†a spokesperson for the Michigan Health Department said in an email.
This problem is global. Amnesty International, in a July report, pointed to widespread data gaps as part of a broader suppression of information and rights that has left workers in many countries “exposed, silenced [and] attacked.†In Britain, where more than 540 medical workers have died in the pandemic, the advocacy group Doctors’ Association UK has begun legal action to force a government inquiry into shortages of personal protection equipment in the National Health Service and “social care†facilities such as nursing homes. And in May, more than three months after the first known medical worker’s death, the International Council of Nurses called for governments across the world to start keeping accurate data on such cases, and for the records to be centrally held by the World Health Organization. The WHO estimates that about 10% of COVID-19 cases worldwide are among health workers. “We are closely following up (on) these cases through our global networks,†a spokesperson said.
“Governments’ failure to collect this information in a consistent way†has been “scandalous,†said the council’s CEO, Howard Catton, and “means we do not have the data that would add to the science that could improve infection control and prevention measures and save the lives of other healthcare workers. … If they continue to turn a blind eye, it sends a message that [those] lives didn’t count.â€
So regular people, like Rezba, have stepped up with their makeshift databases.
Dr. Claire Rezba, an anesthesiologist who tracks the COVID-19 deaths of health care workers. (Carlos Bernate for ProPublica)
Rezba, 40, initially wanted a career in public health. While finishing her master’s degree at Emory University in Atlanta and for a few months afterward, she worked as a lab tech at the CDC, analyzing nasal swabs to track cases of MRSA, the flesh-eating bacteria. But she decided she cared more about people than bugs, so she headed to Virginia Commonwealth University medical school in Richmond, graduating in 2009 with plans to specialize in the treatment of chronic pain.
During her residency at VCU, her first rotation was in the neonatal intensive care unit. “There was a little baby I helped take care of for three weeks. And the very last day of that rotation, his parents withdrew care. … He was the first little person I pronounced dead. I went and cried in the stairwell after that.†Her next rotation was in the burn unit, then the emergency department. “It seemed like death was just everywhere,†Rezba said. Witnessing it “is something very separate from the rest of your life experiences. People look different when they’re dying. It’s not like TV. They don’t look like they’re sleeping. CPR is pretty brutal. Codes are pretty brutal.â€
She began keeping a list as a way to process the grief. “In residency, you record everything — your case logs, the procedures you do. It was just sort of second nature to record their names.†Whenever a patient died she would make another entry in her notebook, then “I would kind of perseverate†— ruminate — “over their names.†At the end of the year, she took the notebook to church. “I lit candles for them. I prayed. And then I let it go.â€
A decade later, Rezba was working full time as an anesthesiologist and raising three small children, her list-compiling days long past her, she thought. Then COVID-19 hit. The onetime infectious disease geek became obsessed with the videos leaking out of China — the teams of health care workers in full protective gear, the makeshift wards in tents, the ERs in chaos: “I knew early on that this was going to be a big problem.†In her job, Rezba was often called upon to do intubations. “The possibility of not having enough PPE caused a lot of anxiety for her,†said her husband, Tejas Patel, whom she met in medical school. “She would be the one, if we did hit that level of New York, who could potentially be at risk and bring it home to the kids.â€
As it turned out, Rezba’s hospital wasn’t inundated, nor did it experience the PPE shortages that plagued many health care facilities. But her anxiety didn’t disappear; it just took a new shape. If health care workers were front-line heroes, she decided, her role was to search the trenches for the bodies left behind.
Rezba is the first to admit she’s not great at technology; she rarely uses a computer at home. Patel discovered what she was doing because their iPhones and iCloud accounts are linked. “Whenever she saves a picture to the phone, I can see it. And I noticed a bunch of pictures of, you know, these strangers.†He remembered how, in their student days, Rezba had insisted on humanizing the cadaver in their anatomy lab: “It upset her that it was just this anonymous person. Knowing his birthday and little things like that would make her feel better.†Patel figured the photos were part of a similar coping strategy. “It wasn’t until much later that I found out she was putting them up on Twitter.â€
Much of Rezba’s digging happens in the middle of the night when she can’t sleep. She usually starts by Googling for local news stories; if she’s still not tired, she turns to the obituary site Legacy.com. The hunt for a person’s occupation and cause of death invariably takes her to Facebook, where she follows the trail to relatives and co-workers, to vacation slideshows and videos of old men serenading their grandkids on the guitar. Every few days, she checks GoFundMe, where she’s recently been struck by the number of people who linger for weeks or months before dying. She’s still discovering deaths that occurred in April and May. Anyone under 60 gets special scrutiny. “If the obit says, ‘They died surrounded by family,’ I usually don’t bother trying to find out more, because those people didn’t have COVID. The people with COVID are mostly dying alone.â€
Doctors and nurses are the easiest to find. “If someone worked in the laundry service at the nursing home, the family doesn’t put that in,†Rebza said. Yet it’s the nonmedical staff that she feels a special obligation to uncover — the intake coordinators and supply techs, the food service workers, and janitors. “I mean, the hospital’s not going to function if there’s nobody to take out the trash.†Every so often, a news story mentions that several staffers from a particular nursing home or rehab center have died, without mentioning their names, and Rezba feels the rage start to bubble. “What it comes down to is, these are people that are making $12 an hour. And they get treated like they’re disposable.â€
If she can’t find someone’s identity right away, or if the cause of death isn’t clear, she’ll wait a couple of days or weeks and try again. Because she comes across them anyway, she’s started to keep track of other categories of COVID-19 deaths, like kids and pregnant women, as well as health care workers in their 30s and 40s who don’t appear to have the virus but suddenly perish from heart attacks or strokes or other mysterious reasons. “I have a lot of those,†she said.
Once she’s certain she’s found someone who belongs on her list, she selects a photo or two and writes a few words in their honor. Sometimes, these read like a scrap of poetry; sometimes, like a howl.
He enjoyed crazy-dancing at home to Bruno Mars, with the moves becoming wilder the more his family laughed.
As a child, she would wrap her clothes around Dove soap so they would smell like America.
This poor baby should have his mother in his arms. Instead, he has her in an urn.
The most important findings: Working in a designated COVID-19 ward didn’t put workers at greater risk of infection while wearing a mask “appeared to be the single most effective approach†to keeping them safe.
In the U.S., many medical facilities are similarly monitoring employee infections and deaths and adjusting policies accordingly. But for the most part, that information isn’t being made public, which makes it impossible to see the bigger picture, or for systems to learn from each other’s experiences, to better protect their workers.
Imagine all of the opportunities it would present if everyone could see the full landscape, said Ivan Oransky, vice president for editorial content at Medscape, where a memorial page to honor global front liners has been one of the site’s best-read features. “You could be doing some real great shoe-leather epidemiology. … You could go: ‘Wait a second. That hospital has 12 fatalities among health care workers. The hospital across town has none. That can’t be pure coincidence. What did this one, frankly, do wrong, and what’s the other one doing right?’â€
To Adia Harvey Wingfield, a sociologist at Washington University and author of “Flatlining: Race, Work, and Health Care in the New Economy,†some of the most pressing questions relate to disparities: “Where is this virus hitting our health care workers hardest?†Is the impact falling disproportionately on certain categories of workers — for example, doctors vs. registered nurses vs. nursing aides — on certain types of facilities, or in certain parts of the country? Are providers who serve lower-income communities of color more likely to become ill?
“If we aren’t attuned to these issues, that puts everybody at a disadvantage,†Wingfield said. “It’s hard to identify problems or identify solutions without the data.†The answers are especially important in Black and Latino communities that have suffered the highest rates of sickness and death — and where health care workers are themselves more likely to be people of color. Without good information to guide current and future policy, she said, “we could potentially be facing long-term catastrophic gaps in care and coverage.â€
The near-term consequences have also been enormous. The lack of public data about health care workers and deaths may have contributed to a dangerous complacency as infections have surged in the South and West, Friese said — for example, the idea that COVID-19 is no more dangerous than other common respiratory viruses. “I’ve been at this for 23 years. I’ve never seen so many health care workers stricken in my career. This whole idea that it’s just like the flu probably set us back quite away.â€
He sees similar misconceptions about PPE: “If we had a better understanding of the number of health care workers infected, it might help our policymakers recognize the PPE remains inadequate and they need to redouble their efforts. … People are still MacGyvering and wrapping themselves in trash bags. If we’re reusing N95 respirators, we haven’t solved the problem. And until we solve that, we’re going to continue to see the really tragic results that we’re seeing.â€
The misconceptions appeared to stretch to the highest reaches of the federal government, even as infections and deaths started surging again. At a White Houseevent in July focused on reopening schools in the fall, HHS Secretary Alex Azartold the people gathered, “health care workers … don’t get infected because they take appropriate precautions.â€
Even some medical workers have continued to be in denial. A few days before Azar spoke, Twitter was abuzz over an Alabama nurse who worked the COVID-19 floor at a hospital by day and decompressed at crowded bars by night, where she often went maskless. “I work in the health care industry,†she was quoted as saying, “so I feel like I probably won’t get it if I haven’t gotten it by now.â€
Piercing that sense of invulnerability — making the enormity of the COVID-19 disaster seem real — isn’t only Rezba’s mission. From The New York Times’ iconic front page marking the first 100,000 American deaths to the Guardian/Kaiser Health News project “Lost on the Frontline,†news organizations and social media activists have grappled with how to convey the scale of the tragedy when people are distracted by multiple world-shattering crises and the normal rituals for processing grief are largely unavailable.
“The point at which accountability usually happens is when our leaders have to reckon with the families of those who’ve been lost, and that has not happened,†said Alex Goldstein, a Boston-area communications strategist behind the wrenching @FacesOfCOVID Twitter account, which has posted almost 2,000 memorials since March. With COVID-19, “no one has had to look in the eye of a crying parent who wants to show you a picture of their child or listen to someone telling you about who their mom or dad was. There has been no consequence. What would our policy decisions have looked like if [the people making them] had to come face to face with that death and loss in a more visceral way?â€
It’s a question that weighs especially heavily on health care professionals, who have seen, in the most visceral way possible, the worst that COVID-19 can do. Erica Bial, a pain specialist in the neurosurgery department at a Boston-area hospital, fell dangerously ill from COVID-19 in March, her respiratory symptoms lingering for more than six weeks. She lived alone and opted not to go to the hospital, in part because she worried about infecting other people. “At that point [in the outbreak], they would have intubated me, given me hydroxychloroquine and azithromycin, and probably killed me.†As her recovery dragged on, she wondered how other doctors were faring: “I couldn’t believe that I was the only physician I knew who was sick.†But as she searched online, “I could not find any data. I just started getting really frustrated at the lack of information and the disinformation. … And then I started thinking about, well, what happens if I die here? Will, anybody knows?â€
Like Rezba, Bill has a background in public health; the Facebook page she created, COVID-19 Physicians Memorial, was an attempt to build “a network where there’s accountability. I wasn’t necessarily trying to create, you know, reverence or memorialization. I was trying to understand the scope of the problem.â€
Rezba soon began posting memorials on the page; as it grew to include more than 4,800 members, Bial asked her to help moderate it. Among the things the two women share is a determination to stick to facts. “I didn’t want any politics and I didn’t want any garbage,†Bial said. “(Rezba) was 100% like-minded and trustable.†She was also someone Bial could talk to, doctor to doctor, as she recovered. “It wasn’t just two people obsessed with something kind of morbid,†Bial said. “She was a source of support.â€
Emergency room doctor Cleavon Gilman also gained a following for his posts on Facebook, a diary about what he witnessed as an ER-resident in the NewYork-Presbyterian hospital system, battling the virus as it engulfed Washington Heights. “It was just … overwhelming,†he recalled. “We were intubating 20 patients a day. We had hallways filled with COVID patients; there was nowhere to put them.†In the space of a few brutal days in late April, three of Gilman’s colleagues died, including one by suicide. “When it’s a colleague that you’re taking care of and you know them as a person you’ve been on a journey with … man, that’s hard.â€
Though much of the media focus was on the risks faced by older patients, Gilman was struck by how many of the critically ill were in their 20s, 30s, and 40s. In mid-April, his own 27-year-old cousin, a gym teacher at a New Jersey charter school, suddenly died; he went to the ER twice with chest pain but was diagnosed with anxiety and sent home, according to his relatives, only to collapse in his car on the side of the road.
As the crisis in New York City ebbed, Gilman could see trouble ahead in other parts of the country, including in Yuma, Arizona, where he was about to start a new job. It seemed vitally important to help younger people understand the risks they faced — and that they created for others — by not adhering to physical distancing or wearing masks, not to mention the dangers that health care workers faced from continuing shortages of PPE. So Gilman began gathering the memorials he saw on Twitter and Facebook, many of them found by Rezba or on @FacesOfCOVID, and organizing the dead on his website in the type of gallery that he knew would pack an emotional wallop. Then he went a step further, making the photos and obituaries — more than 1,000 people — sortable by age and profession.
“You begin to see a pattern here,†he said. “When someone says, ‘Oh people aren’t dying, they’re not that [young],’ you can come back with actual names, actual articles, quickly. It’s more powerful. You have your evidence there.â€
One of the most overtly political projects is Marked by COVID, formed by Kristin Urquiza in honor of her father, Mark after her “honest obituary†of him went viral in early July. To Urquiza, who earned her master’s in public affairs from the University of California, Berkeley, and works as an environmental advocate in the San Francisco area, “the parallels between the AIDS crisis and what is happening now with COVID are just mind-boggling [in terms of] the inaction by governments and the failure to prioritize public health.†She and her partner, Christine Keeves, a longtime LGBTQ activist, hope the project will be both “a platform for people to come forward and share their stories†and the COVID-19 version of the anti-AIDS group Act Up.
They’re also raising money on GoFundMe to help other families pay for obituaries; the second honest obit on their site was for a respiratory therapist in Texas named Isabelle Odette Hilton Papadimitriou: “Her undeserving death is due to the carelessness of politicians who undervalue healthcare workers through lack of leadership, refusal to acknowledge the severity of this crisis and unwillingness to give clear and decisive direction to minimize the risks of coronavirus. Isabelle’s death was preventable; her children are channeling their grief and anger into ensuring fewer families endure this nightmare.â€
It’s a trend that Rezba supports wholeheartedly. By the end of July, she had posted almost 900 names and faces of U.S. health care workers who had perished from COVID-19. She fantasized about what it would be like to leave the counter behind her. “It would be great if I could stop. It would be great if there was nobody else to find.†But she had a backlog of dozens of stories to post, and the number of deaths kept climbing.
Diamond Valley Federal Credit Union recently received the Governor’s Half Century Business Award recognizing their longstanding service in the community, according to Vanderburgh County legislators.
“Southwest Indiana is ideal for business development and perfect for companies to thrive and help our communities flourish,” said State Rep. Holli Sullivan (R-Evansville). “This recipient is a great example of the success job creators can have if they locate to Vanderburgh County. Congratulations to on staying in business for more than 50 years.”
According to State Rep. Wendy McNamara (R-Evansville), Diamond Valley Federal Credit Union in Vanderburgh County was recognized for remaining in operation for 59 consecutive years in Indiana and demonstrating a commitment to serving the community.
“Owning and operating a successful business is something to be proud of and celebrate,” McNamara said. “Diamond Valley Federal Credit Union has served our friends and community for many years and I wish them all the best in the future.”
The 76 Indiana companies and organizations honored with the Governor’s Century or Half Century Business awards will be invited to participate in the 2021 ceremony, with this year’s spring ceremony postponed.
“Hoosiers support small businesses because they know those same companies are giving back to the local community,” said State Rep. Matt Hostettler (R-Fort Branch). “For decades the Diamond Valley Federal Credit Union has served Vanderburgh County and the surrounding areas, and I wish them continued success for many more years.”
More than 1,560 Hoosier businesses have been recognized during award’s 29-year history.
INDIANAPOLIS — The Indiana State Department of Health (ISDH) today announced that 784 additional Hoosiers have been diagnosed with COVID-19 through testing at ISDH, the Centers for Disease Control and Prevention (CDC) and private laboratories. That brings to 67,857 the total number of Indiana residents known to have the novel coronavirus following corrections to the previous day’s dashboard.
A total of 2,775 Hoosiers are confirmed to have died from COVID-19, an increase of four over the previous day. Another 200 probable deaths have been reported based on clinical diagnoses in patients for whom no positive test is on record. Deaths are reported based on when data are received by ISDH and occurred over multiple days.
As of today, more than 37 percent of ICU beds and nearly 85 percent of ventilators are available across the state.
To date, 769,043 tests for unique individuals have been reported to ISDH, up from 758,606 on Saturday.
Beginning Tuesday, ISDH will be offering free testing this week from 9 a.m. to 6 p.m. in the following counties: Brown, Elkhart, Jasper, Kosciusko, LaGrange, Lake, Marshall, Perry, Spencer, Switzerland, Tippecanoe and Wells. For locations or to find other testing sites around the state, visit www.coronavirus.in.gov and click on the COVID-19 testing information link.
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A global pandemic ravaging America is no time to forget the first rule of American health care: There is no set price. One out-of-network medical provider in Texas seeks permission from patients to charge fees as high as six-figures to their insurance.
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As she waited for the results of her rapid COVID-19 test, Rachel de Cordova sat in her car and read through a stack of documents given to her by SignatureCare Emergency Center.
Without de Cordova leaving her car, the staff at the freestanding emergency room near her home in Houston had checked her blood pressure, pulse and temperature during the July 21 appointment. She had been suffering sinus stuffiness and a headache, so she handed them her insurance card to pay for the $175 rapid-response drive-thru test. Then they stuck a swab deep into her nasal cavity to obtain a specimen.
De Cordova is an attorney who specializes in civil litigation defense and maritime law. She cringes when she’s asked to sign away her rights and scrutinizes the fine print. The documents she had been given included disclosures required by recent laws in Texas that try to rein in the billing practices of stand-alone emergency centers like SignatureCare. One said that while the facility would submit its bill to insurance plans, it doesn’t have contractual relationships with them, meaning the care would be considered out-of-network. Patients are responsible for any charges not covered by their plan, it said, as well as any copayment, deductible or coinsurance.
The more she read, the more annoyed de Cordova became. SignatureCare charges a “facility fee†for treatment, the document said, ranging “between five hundred dollars and one hundred thousand dollars.†Another charge, the “observation fee,†could range from $1,000 to $100,000.
De Cordova didn’t think her fees for the test could rise into the six figures. But SignatureCare was giving itself leeway to charge almost any amount to her insurance plan — and she could be on the hook. She knew she couldn’t sign the document. But that created a problem: She still needed to get her test results.
Even in a public health emergency, what could be considered the first rule of American health care is still in effect: There is no set price. Medical providers often inflate their charges and then give discounts to insurance plans that sign contracts with them. Out-of-network insurers and their members are often left to pay the full tab or whatever discount they can negotiate after the fact.
A portion of the document given to Rachel de Cordova at SignatureCare highlighted by ProPublica describes fees for the “facility†and “observation†that could reach $100,000 each. (Obtained by ProPublica)
The CARES Act, passed by Congress in March, includes a provision that says insurers must pay for an out-of-network COVID-19 test at the price the testing facility lists on its website. But it sets no maximum for the cost of the tests. Insurance representatives told ProPublica that the charge for a COVID-19 test in Texas can range from less than $100 to thousands of dollars. Health plans are generally waiving out-of-pocket costs for all related COVID-19 treatment, insurance representatives said. Some costs may be passed on to the patient, depending on their coverage and the circumstances.
As she waited, de Cordova realized she didn’t want to play an insurance roulette. She changed her mind and decided she’d pay the $175 out-of-pocket for her test. But when the SignatureCare nurse came to collect the paperwork, de Cordova said the nurse told her, “You can’t do that. It’s insurance fraud for you to pay for our services once we know you have insurance.â€
Dr. Hashibul Hannan, an emergency room physician, lab director and manager at SignatureCare, told ProPublica his facility is an emergency room that offers testing, not a typical testing site. He said de Cordova should have been allowed to pay the $175 cash price. The staff members were concerned about being accused of fraud because they had already entered her insurance information into the record, he said. So they didn’t want it to appear she was being double-billed. Hannan also said he regrets that she was upset by the disclosure forms that are now required under state law.
Unable to pay cash and unwilling to take a chance on the unknown cost, de Cordova decided to leave without getting the results of her COVID-19 test.
“I Would Have Signed Anythingâ€
Later that day, de Cordova couldn’t get past what happened. She wondered what happened to patients who didn’t read the fine print before signing the packet.
Then she realized she and her husband, Hayan Charara, could investigate it themselves. In June, the couple’s 8-year-old son had attended a baseball tryout. They thought the kids would be socially distanced and that precautions would be taken. But then the coaches had crowded the players in a dugout, with no masks or social distancing, and a couple days later the boy said he wasn’t feeling well.
So just to be safe, on June 12, Charara took their son to the same SignatureCare, the Heights location, for a COVID-19 test. The line was so long they had to wait for hours, go home, come back and wait for hours again in their car in the 100-degree heat. Charara, a poet who teaches at the University of Houston, said he didn’t take a close look at the financial disclosure paperwork. De Cordova wasn’t with them. It had been 10 hours of waiting by the time the boy was tested, so “I would have signed anything,†he said. (The child tested negative.)
Charara, de Cordova and their children are covered by the Employees Retirement System of Texas, a taxpayer-funded benefit plan that covers about half a million people. They hadn’t received any notices about the charges for their son. So they contacted the SignatureCare billing department and asked for an itemized statement. The test charge was true $175. But the total balance, including the physician and facility fees associated with an emergency room visit, came to $2,479.
The facility fee was $1,784 and the physician fee $486.
The couple was dumbfounded. Their son’s vital signs had been checked but there had been no physical examination, they said. The interactions took less than five minutes total, and the child stayed in the car. “You’re getting a drive-thru test, and they’re pretending like they’re giving you emergency services,†de Cordova said.
The statement for de Cordova’s son’s evaluation and $175 COVID-19 test came to $2,479 after fees added by SignatureCare. (Obtained by ProPublica)
The SignatureCare charges shocked experts who study health care costs. Charging $2,479 for a drive-thru COVID-19 test is a “nauseating†example of profiteering during a pandemic, said Niall Brennan, president and CEO of the Health Care Cost Institute, a nonprofit organization that studies health care prices. “It’s one of the most egregious examples of giving the fox the keys to the henhouse I’ve ever seen and yet another example of the absurdity of U.S. health care pricing.
“Imagine a vendor in any other walk of life being allowed to bill a third party for whatever amount they wanted,†Brennan said.
Insurance companies in Texas typically pay between $100 and $300 for drive-thru COVID-19 tests, said Jamie Dudensing, CEO of the Texas Association of Health Plans. But the association’s members have seen hundreds of out-of-network COVID-19 test charges come in far higher, some in the thousands of dollars.
“There’s no excuse for that, especially in a public health crisis,†said Chris Callahan, spokesperson for Blue Cross and Blue Shield of Texas, which likewise has seen high charges for COVID-19 tests from out-of-network providers.
The reimbursement rates negotiated between insurance companies and in-network providers are much lower, but they still vary, according to data provided by the nonprofit FAIR Health, which tracks spending by private insurers. For the same test billed by SignatureCare, an in-network insurer pays a median price of $23 in Utah and $75 in Wisconsin, according to FAIR Health estimates.
Texas is notorious for its high-priced out-of-network emergency bills and free-standing emergency departments. Some of the facilities appear to be using COVID-19 testing to draw in patients so their insurance plans can be charged for additional services, said Blake Hutson, associate state director for AARP Texas, the advocacy organization for older Americans. “It’s not a surprise they would be racking up the charges and adding on everything they can and billing the health plan,†he said.
In some cases, insurers do pay the exorbitant out-of-network charges, Hutson said, but they typically get reduced. In 2019, Texas lawmakers voted to ban billing patients in state-regulated insurance plans for charges not covered by their policy, Hutson said, which is known as “balance†or “surprise†billing. But consumers may still be responsible for any deductibles and other cost-sharing under their health plan. And the costs covered by the health plan get passed back to the consumers over time in the form of higher premiums, he said. “It’s all problematic for the cost of care,†Hutson said.
Hannan defended SignatureCare’s high out-of-network charges by blaming insurance companies for refusing to give what he considers to be fair in-network rates. The charges are a starting point for negotiating a fair deal from out-of-network insurance plans, he said. He described SignatureCare, which has 18 locations, as “small players. When it comes to negotiating with insurance companies, we have no luck.â€
Was the Bill Accurate?
The medical record portrays the visit as an emergency and contains details that are not consistent with how Charara and de Cordova describe their son’s condition. The chief complaint in the record is “body fluid exposure,†and elsewhere it says “confirmed COVID exposure.â€
But that’s not accurate, according to the parents. No one had coughed or sneezed on their son, and they knew of no one from the tryout who had tested positive for COVID-19, they said. The child’s temperature is registered in the record as 102.8, which is high. But Charara said that could have been caused by sitting in the Texas heat, waiting for the test.
Shelley Safian, a Florida health care coding expert who has written four books on medical billing, examined the bill and medical records of Charara and de Cordova’s son at ProPublica’s request. She said the medical records don’t justify the charges. SignatureCare billed the case as if the exam were an emergency that required an “expanded problem focused history†and “medical decision making of moderate complexity,†she said.
In order to qualify for reimbursement of an exam at that level, the encounter would need to include examining the affected organ system, Safian said. But the medical records do not document any check of the respiratory system, which would be indicated for suspected COVID-19.
Much of the medical record appeared to be cut and pasted from other electronic records, Safian said. “This is boilerplate B.S.,†she said, “and I don’t mean ‘bachelor of science.’â€
Hannan, the SignatureCare doctor and manager, stands by the charges associated with the child’s COVID-19 test. The facility has to treat every case like a possible emergency, and that requires an examination, he said. He pointed out that the charges are in line with what other out-of-network providers would charge in the area, according to FAIR Health, though they are far higher than in-network prices.
A doctor’s examination may not be as hands-on during COVID-19, but, similar to a telemedicine visit, a lot can be examined visually, Hannan said. Hannan said the company he uses for coding said COVID-19 requires a higher level of care and vigilance because it’s an infectious disease.
In light of the questions raised by ProPublica and Safian, Hannan said he asked his billing company to audit the charges. Sharon Nicka, president and CEO of Nicka and Associates, the billing company used by SignatureCare, took issue with Safian’s assessment and said the billing codes used were justified by the medical record. She said the charges are high for a drive-thru test, but those are set by SignatureCare.
ProPublica identified several apparent errors and contradictions in the medical record and billing documentation. For example, the notes in the medical record alternatively refer to the boy as “symptomatic†and “asymptomatic.†The record also says the physical exam showed a skin wound that “was not red, swollen or tender,†but the child had no wound of any kind, the family said. And the billing documentation shows a charge for an antibody test when the medical record showed that the patient actually received a diagnostic test, which is something different.
In response to ProPublica’s questions, a SignatureCare medical director reviewed the record. The error about the “wound†may have been caused by a software template adding something that was not in the physician chart, the reviewer wrote. The facility now uses a different template. The charge for the antibody test is likely a billing error, as the physician had ordered the correct test, the reviewer wrote. “We will continue to update and improve our (electronic medical records),†the reviewer said.
Hannan stressed that SignatureCare is upfront with patients about the possible fees associated with its treatment, including the disclosure paperwork and explanations on its website. It’s an emergency room, he said, so patients should expect emergency room fees. Patients who do not have a medical emergency should not come, he said, though the ER allows patients to book appointments a day in advance for a COVID-19 test.
Dudensing, the chief executive of the Texas Association of Health Plans, said she’s heard Hannan’s contention before and it’s true that freestanding emergency rooms have a license that allows them to charge more. But she still believes that they handle many non-emergency cases and are forcing facility fees of thousands of dollars on them. “They’re hiding under the guise of emergency rooms when they’re really dressed-up urgent care,†she said.
Diana Kongevick, director of group benefits for the Employees Retirement System of Texas, said the health plan had only recently received the bill for the 8-year-old’s test. It hadn’t been processed, so she could not speak to it directly. But, in general, the health plan will pay 100% of the cost of the test, in this case $175, she said. The claim would be processed using out-of-network provisions, she said. So for the other charges, the patient may be responsible for paying in the range of $600, she estimated, for the out-of-network copay and deductibles. “This is a nonemergent patient self-referral to an out-of-network provider,†Kongevick said.
“Testing Should Be Freeâ€
Even if the Employees Retirement System of Texas determines that Charara and de Cordova should pay $600 for their son’s test, SignatureCare will not be sending the family a bill, Hannan said. He said insured patients are not being sent bills for COVID-19 treatment beyond what their insurance companies cover.
De Cordova never did get her test results, and she didn’t seek a test elsewhere. She felt better later and now believes she had just been suffering from allergies. But what if it had turned out to be COVID-19, she wondered. Might she have gone on to infect others, she’s asked herself.
From a public health perspective, the haggling about out-of-network charges and payments puts patients in the middle, and it might discourage them from getting tested for COVID-19 during the pandemic, said Stuart Craig, an economist at the University of Pennsylvania who studies health care costs. “It’s another part of the fragmentation of the health care system that makes patients’ lives miserable,†Craig said.
It’s especially frustrating, he said, because COVID-19 testing is so essential to making it safely through the pandemic. Craig said he believes there should be a nationally mandated price and government subsidies to make sure medical providers and manufacturers are motivated financially to provide tests. “Testing should be free,†Craig said. “In fact, we should probably be paying patients to get tested.â€
BOARD OF PARK COMMISSIONERÂ REGULAR MEETINGÂ KEVIN WINTERNHEIMER CHAMBERSÂ ROOM 301, CIVIC CENTER COMPLEXWEDNESDAY, AUGUST 5, 2020Â 12:00 NOON
  AGENDA
1.    CALL TO ORDER
2.    MEETING MEMORANDUM JULY 15, 2020
3.    CONSENT AGENDAÂ
      a. Request Re: Approve and Execute Extension of Concessions Agreement for Swonder  Ice Arena and Hartke Pool with Ice House Treats, LLC.- HoltzÂ
      b. Request Re: Approve and Execute Extension of Concessions Agreement for Helfrich  Golf Course with Ice House Treats, LLC.- Holtz c. Request Re: Approve and Execute Extension of Concessions Agreement for Fendrich Golf Course with Pattie’s Sand Trap.- Holt
  OLD BUSINESS Â
                                                             5.     NEW BUSINESSÂ
      a. Request Re: Property Access for Environmental Investigation – Holtz     Â
       REPORTS
      a. Eric Beck – Executive Director Mesker Park Zoo & Botanic Garden b. Brian Holtz- Executive Director of Parks and Recreation
7. Â Â Â Â ACCEPTANCE OF PAYROLL AND VENDOR CLAIMS