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Culture of Concealment in Michigan: Resettlement Agencies Hiding Refugee Latent TB Infection Rates

The Michigan Department of Health and Human Services, most county health departments in the state, and the local Michigan offices of refugee resettlement agencies are hiding refugee latent tuberculosis (TB) infection rates from the public.

Michigan’s culture of concealment stands in contrast to how several other states deal with latent TB infection rates among refugees.

As Breitbart News reported, the Michigan Department of Health and Human Services (MDHHS) does not collect latent TB infection rate data from the county health departments and local resettlement agency providers it hires to conduct initial domestic medical screenings for arriving refugees, nor does it acknowledge its clear legal obligation to do so under the Refugee Act of 1980.

“We do not have that data,” MDHHS spokesperson Bob Wheaton told Breitbart News when asked for data on LTBI infection rates based on the entire population of refugees screened.

MDHHS has hired several county health departments and, in some counties, private refugee health screen services working in cooperation with local resettlement agencies to conduct initial domestic medical screenings of arriving refugees. Under Centers for Disease Control (CDC) and MDHHS guidelines, every refugee who completes such a screening is tested for latent TB infection.

But MDHHS says neither the counties nor the private refugee health screening services share this data with them, and the counties and private refugee health screening services who have the refugee latent TB infection data refuse to make that information public.

In the case of at least one private refugee health screening service, the Arab American and Chaldean Council, which MDHHS has hired to conduct refugee health screenings in Wayne County, Macomb County, and Oakland County, that data is also not being shared with health departments in those counties. Providing that data to local county health departments is a requirement of the Refugee Act of 1980.

As Breitbart News has reported, a number of states routinely make this important public health data available in annual reports: Minnesota, where the latent TB infection rate among newly arrived refugees in 2014 was 22 percentIndiana (26 percent),  Arizona (18 percent), Utah (18 percent)Texas (15 percent), and California (12 percent), and Florida (12 percent).

Other states and resettlement agencies have made the data available after repeated requests from Breitbart News: Tennessee (27 percent)Vermont (35 percent), and Idaho (21 percent).

Identifying and treating refugees who arrive with latent TB infection rates is an important element in state and national TB control programs because numerous medical studies, including one conducted at the University of California at San Diego in 2013, have shown that high rates of latent TB infection among resettled refugees pose a public health risk to the general public in communities in which they have resettled.

Latent TB becomes a health risk when it activates into active and infectious TB, a process usually associated with a lowered level of immunity among patients who have latent TB.

Four percent of the general population in the United States has latent TB infection. Ten percent of this group develops active TB at some point in their life.

In contrast, 33 percent of the population in the rest of the world has latent TB infection. When refugees arrive in the United States from other parts of the world with latent TB infection, medical studies suggest that their activation rate is higher than ten percent, due to a number of factors that reduce their immune systems, including crowded living circumstances, failure to initiate or complete latent TB infection medical treatment, and lifestyle choices, such as smoking.

Though it refuses to provide latent TB infection rate data on refugees, Michigan is one of fifteen states for which Breitbart News has obtained data on the number of refugees diagnosed with active TB.

All told, 468 refugees have been diagnosed with active TB in these fifteen states:

Minnesota (296), Wisconsin (27)Nebraska (21)Louisiana (21), Michigan (19)Vermont (17)Colorado (16), Florida (11), Ohio (11 in one county)Idaho (7), Kentucky (9 in one county)North Dakota (4 in one county),  Indiana (4), California (3), and Tennessee, where two refugees have been diagnosed with the very dangerous, multi-drug resistant (MDR) TB.

The vast majority of the more than 4,000 refugees who arrived in Michigan in FY 2016 were resettled in eight counties: Wayne, Oakland, Macomb, Kent, Ingham, Washtenaw, Calhoun, and Kalamazoo.

MDHHS says it has contracted with the county health departments in Kent County, Calhoun County, and Ingham County to conduct initial domestic medical screenings of refugees resettled in their jurisdictions. It has contracted with the Arab and American Chaldean Council to conduct initial domestic medical screenings in Wayne County, Macomb County, and Oakland County. In September 2015, it switched its contracted refugee health service screener in Washtenaw County from the Washtenaw County Health Department to St. Joseph’s Hospital. In Kalamazoo County, it has contracted with a local private service rather than the Kalamazoo County, according to the Kalamazoo County Health Department.

Breitbart News has contacted all eight county health departments in these counties.

Two counties that conduct their own initial domestic medical screenings of refugees (Kent and Ingham) have refused to provide latent TB refugee health data. One county that conducts its own initial domestic medical screening for refugees (Calhoun) says it will not be able to provide that data until November. The one county that previously conducted its own domestic medical screening of refugees (Washtenaw) says the data is not readily available.

Three of the four counties in which domestic medical screenings of refugees have been conducted by a private service for several years (Oakland, Macomb, and Kalamazoo) tell Breitbart News they do not have latent TB refugee health data in their possession. One of the four counties in which domestic medical screenings of refugees have been conducted by a private service for several years (Wayne County) has not responded to Breitbart News’ inquiries.

In Kent County (Grand Rapids), a longtime destination for refugees from high TB-burden countries, the Kent County Health Department is refusing to offer any public explanation for a huge spike of foreign-born cases of TB in 2011. In that year, the Michigan public health region that includes Kent County, population 602,000, and eleven surrounding rural counties with smaller populations, reported 22 foreign-born cases of active TB. (See page 24 of the 2009-2013 Michigan Tuberculosis Epidemiologic Trends Report, published by the Michigan Department of Community Health.)

Breitbart first asked Kent County about latent TB rates among refugees and the 2011 TB spike on September 10.

One month later, on October 13, after several subsequent email exchanges, a spokesperson for Kent County told Breitbart News, “Due to potential HIPAA concerns identified through our data collection process, the data request is under legal review. We will reply accordingly as soon as possible.”

When Breitbart News responded that HIPAA claims for aggregate data are entirely unwarranted, the spokesperson responded, “We will need your data inquiry processed as a FOIA.We will respond to this inquiry after receipt of a FOIA request.”

It’s a similar story in Macomb, Wayne, Ingham, Calhoun, Washtenaw, and Kalamazoo counties, other primary locations for refugee resettlement in Michigan.

“The data you are requesting is contained in the Federal EDN [Electronic Disease Notification] system, not in any Macomb County system,” a spokeperson for the Macomb County Health Department tells Breitbart News.

“No, that data is not in the Federal EDN system,” Breitbart responded, and posed this follow-up question:

The vendor selected by the state of Michigan to conduct domestic medical screenings in Macomb County, the Arab-American Council, has the data.

According to the Refugee Act of 1980, they are supposed to provide that data to Macomb County Public Health.

Are they providing you that data or not?

Breitbart News has not received a response to that question from the Macomb County Health Department.

In Macomb County, one member of Secure Michigan, a local grassroots group, has repeatedly attempted to contact County Executive Mark Hackel, to no avail:

Here is the timeline on trying to reach out to Macomb County Executive Mark Hackel to see what position he is taking on the refugees coming into Macomb County. I’m sure he is a welcoming partner, since he developed “One Macomb.”

I first left a message for him through one of his assistants back on Sept. 14th.

I called back again on Sept. 21st saying I received no response back on setting up a possible meeting with Mr. Hackel. They said they would again forward my message. I called on Oct. 11th. to say this was my third time calling, and the assistant said I should email Kim Elward, Executive Assistant at the Macomb County Executive Office. I have emailed and still no response to my request from a Secure Michigan spokesperson for a meeting with Mr. Hackel to provide him with the economic, health, and security concerns of refugees being seeded into Macomb County and our state.

“We are no longer the provider for local health refugee screening (as of September 2015),” a spokesperson for the Washtenaw County Public Health Department (Ann Arbor) tells Breitbart News:

Prior to that time we did health screenings and reported to the Michigan Department of Health and Human Services (MDHHS) as required. The information reported does not necessarily address all of your questions. In addition, our local information is not in a format that can be quickly reported to you within the time frame you requested it. I will provide an update as soon as possible and/or ask you to submit a public information request as needed.

When pressed by Breitbart News to provide latent TB infection rates among arriving refugees during the period Washtenaw County conducted refugee health screenings, the spokesperson said, “We are working to compile this information, where we can, from our records.”

“While I can compile information in response to your request, I will not be able to meet your deadline of 9am EST Friday, Oct 14th,” a spokesperson for the Calhoun County Health Department tells Breitbart News, adding that a response will come “probably not until early November. We are booked solid with Flu clinics currently.”

Wayne County’s director of the Department of Health, Veterans, and Community Wellness, Dr. Mouhanad Hammami, did not respond to Breitbart News’ request for details on latent TB infection rates among arriving refugees in that jurisdiction.

The Ingham County Health Department also did not respond to Breitbart News’ request for details on latent TB infection rates among arriving refugees in their jurisdiction.

“Kalamazoo County Health Department does not complete Refugee Medical Screenings, so we do not have the records you have requested. I would recommend reaching out to the State of Michigan (Michigan Department of Health & Human Services) directly for this data,” a spokesperson for the Kalamazoo County Health Department tells Breitbart News.

In contrast to every other Michigan county health department contacted by Breitbart News, Oakland County has been responsive and provided all the available data in its posession, which did not include latent TB infection rates of arriving refugeees because the state contracted health refugee assessment provider, the Arab American Chaldean Council (ACC), whose legal duty it is to provide that data to Oakland County, is apparently is not sharing that data with the county.

Breitbart News has contacted ACC several times but has received no response.

Oakland County Executive L. Brooks Patterson has said he intends to sue the federal government for its resettlement of refugees within the county’s jurisdiction without complying with the Refugee Act of 1980’s consultation clause. That clause requires the federal government and the director of the Office of Refugee Resettlement to consult with executives of state and local governments prior to the resettlement of refugees within their jurisdictions.

“Secure Michigan supports the efforts of Brooks Patterson to protect the citizens of Oakland County, by utilizing the legal system as necessary as necessary based on the gross failure of the refugee industry to consult with the county government while delivering more than 10,000 refugees to the county including recently more than 4% of the national total of unvetted Syrian refugees,” a spokesperson for the local Michigan grassroots group tells Breitbart News:

The situation in Macomb County is different. The county government has been more than complicit in transforming the county via refugees including recently more than 3 percent of the total of national total of unvetted Syrian refugees. The inability for citizens of Macomb County to receive vital refugee health information should be alarming to families with children in schools and to other vulnerable communities. Mental health issues like PTSD are a particular problem for refugee families. Will it take individual citizens as part of a class action lawsuit to pry the health records from the county government?

Many state and local governments around the country exhibit Michigan’s culture of concealment when it comes to reporting both latent TB infection rates among refugees and active TB cases diagnosed among refugees. In fact, the majority of the fifty states currently do not make data on refugee latent TB infection rates or the number of refugees diagnosed with active TB available to the public.

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