Tennessee Health Dept. and Catholic Charities Fail to Make Refugee TB Health Data Public

Tuberculosis (Karin Schermbrucker / Associated Press)
Karin Schermbrucker / Associated Press

NASHVILLE, Tennessee—Both the Tennessee Department of Health and the VOLAG (voluntary agency) that administers the refugee resettlement program in the Volunteer State, Catholic Charities of Tennessee’s Tennessee Office for Refugees, are failing to make public critical information on refugee tuberculosis (TB) health care.

Breitbart News asked the two organizations to provide the following refugee TB healthcare data, which several other states make public on an annual basis, but neither provided it:

• The percentage of refugees who successfully completed medical screenings within 90 days of their arrival, as recommended by the Centers for Disease Control (CDC).
• The percentage of refugees who tested positive for Latent Tuberculosis Infection (LTBI).
• The percentage of refugees who tested positive for LTBI who completed medical treatment.
• The number of refugees who were diagnosed with active TB upon their arrival in Tennessee.

Tennessee is one of fourteen states that have withdrawn from the federal refugee resettlement. In those states, the Office of Refugee Resettlement has selected a VOLAG to run the refugee resettlement operations under the statutorily questionable Wilson Fish alternative program.

The Tennessee General Assembly passed a resolution in April to sue the federal government for its operation of the refugee resettlement program on Tenth Amendment grounds. In May, Gov. Haslam chose not to veto the resolution, so a lawsuit is in the works, though Tennessee’s embattled Attorney General Herbert Slatery could raise an objection impacting the Tennessee General Assembly’s standing.

At least seven states that are not part of the Wilson Fish alternative program, California, Utah, Arizona, Texas, Minnesota, Indiana, and Florida, regularly report on the health data, tuberculosis and otherwise, of refugees resettled in their states.

Breitbart News asked both the Tennessee Department of Health and Catholic Charities of Tennessee’s Tennessee Office for Refugees (TOR) why they are failing to make public this important refugee health data, in light of the fact that other states are doing so.

“There is no uniform list of reportable conditions state health departments in the United States must collect; we may collect some in Tennessee that other states do not and vice versa,” a Tennessee Department of Health spokesperson tells Breitbart News. “I provided our list so you can see how comprehensive it is. We’ve provided a federal resource for you that may have information we do not,” the spokesperson adds.

The spokesperson said that the Tennessee Department of Health has provided all the information it has available as it relates to refugee health.

“I want to emphasize the Tennessee Department of Health is not withholding or failing to provide information,” the spokesperson tells Breitbart News.

No representative of TOR, the VOLAG operating in the state of Tennessee, responded to any of Breitbart’s inquiries.

The refugee health data made public in these seven states, but concealed in Tennessee, is alarming.

Indiana, for instance, reported that four refugees with active TB arrived in the Hoosier State in 2015.

Cases of active TB in the United States increased in 2015, the first time after steadily declining for 23 years. During that same period, the percentage of active TB cases that are foreign-born has increased dramatically.

Over that 23 year period, 70,000 refugees per year, on average, have entered the United States.

Latent TB infection rates among refugees reported by the public health departments in the states that have made this data public range from 18 percent in Utah to 22 percent in Minnesota to 26 percent in Indiana.

In the general population of the U.S., the latent TB infection rate is only 4four percent.

As multiple reports have concluded, these high latent TB infection rates in refugee resettlement communities represent a public health risk to all.

One 2013 study, for instance, concluded that:

Assessment of LTBI prevalence and treatment among recently arrived refugees is needed to effectively address the control of TB, because untreated, reactivated LTBI in this population may be an important contributor to TB incidence in the United States.

But Tennessee residents have been left in the dark about the public health risk posed to them by the 1,601 refugees who entered the state in 2015, and the more than 10,000 that have entered over the past two decades. Neither the Tennessee Department of Health nor the TOR provided Breitbart News with the LTBI rate of these refugees or whether any of them arrived in the state with active TB.

The Tennessee Dept. of Health did, however, provide Breitbart News with data related to one issue: The number of B1,B2, and B3 Tuberculosis health notifications received between 2010 and 2015:

Number of tuberculosis B1, B2, B3 notices provided to the state by the CDC of incoming refugees—2010-2015

Year                                      2010       2011       2012       2013       2014       2015
# of Arrivals                      80          54           103           97          122           80
Source: CDC Electronic Disease Notification System (EDN)

The department also provided data and the number of active TB cases broken down by US-born, foreign-born, and refugees for the period, 2010-2015, though it did not provide the number of those from refugees, as the Minnesota Department of Health, for instance, has done.

Number of Active Tuberculosis Cases, 2010-2015

Year                                   2010        2011       2012       2013       2014       2015
U.S.-born                         123           101           111          102           85           72
Foreign-born                   70              55            52            41           66           59
Refugees                                            -Data not reported-
Total                                   193            156          163           143         151        131
Source: National Electronic Disease Surveillance System (NEDSS)

“I also want to again emphasize Tennessee’s TB has been on a downward trend for many years,” the spokesperson adds.

The percentage of foreign-born cases of TB has increased during this time period from 36% in 2010 to 45 percent in 2015.

During that same time period, the number of refugees arriving in the state annually has remained around 1,600 (It was 1,600 in 2010 and 1,601 in 2015).

A possible clue to the failure of the VOLAG running the refugee resettlement program in Tennessee for the federal government may be found in the mission given to it in the statutorily questionable Wilson Fish alternative program guidelines issued by the Office of Refugee Resettlement (ORR), which stands in marked contrast to the mission given to departments of health in other states that still operate under the Refugee Act of 1980.

VOLAGs have turned the operation of refugee resettlement programs into a lucrative industry funded by the federal government. Last year, the federal government paid them more than $1 billion. The current proposed budget by the Obama administration would increase that amount to $2 billion in FY 2017.

On its website, TOR describes itself as:

… a department of Catholic Charities of Tennessee, Inc. designated by the federal Office of Refugee Resettlement (ORR) to administer the state refugee resettlement program. Funded by ORR, the Tennessee Refugee Program helps refugees statewide access cash and medical assistance, initial medical screenings, employment, social adjustment services, and English language training in an effort to achieve self-sufficiency.

The ORR offers guidelines to the mission of a VOLAG running the refugee resettlement programs in Wilson Fish alternative program states, “[t]he lead-WF agency is responsible for the oversight of the distribution of RCA and (if applicable) RMA/Medical Screening benefits to eligible clients.”

The guidelines further define the responsibilities of the VOLAG:

Statewide Coordination Requirements of the WF-SRC/Lead WF agency:

a. Plan and coordinate program services with state and local community service providers (public and private) by holding quarterly meetings and by regular communication. . .
f. Submit timely and accurate programmatic and financial reports as detailed in the WF program guidelines from ORR.
Requirements of the WF Statewide Refugee Coordinator:
a. The WF SRC has a fiduciary duty to serve the best interests of all of the state’s refugees. Decisions pertaining to the administration of the statewide refugee program should be transparent and should be implemented in a fair and equitable manner amongst all of the state’s agencies that participate in the WF program…
d. The WF SRC must coordinate with all agencies providing assistance and services to refugees in the state.
e. The WF SRC must meet with and educate community partners and the public at large to advocate for refugees.

The TOR mission statement and WF guidelines, which emphasize that they serve refugees, not taxpayers, differs significantly from the mission statements of departments of health in non W-F states. The State of Indiana Refugee Health Program 2015 Annual Report provides an example of that contrast:

The Refugee Health Program at the Indiana State Department of Health (ISDH) is responsible for providing oversight and coordination of health services to refugees in Indiana.
The mission of the Refugee Health Program is to support the resettlement of refugees by providing access and resources for an initial health screening upon arrival to the United States,by identifying emerging health issues in refugee populations and to provide ongoing support through relationships with community, state and federal partners.
The ISDH Refugee Health Program has made significant progress, including reaching the milestone of 100 percent of refugees receiving screening within 30 days of arrival during the last quarter of 2015 and the expansion of screening services to include newborn, tobacco and mental health screening.

News that TOR is withholding important refugee health data from the public in Tennessee will likely boost the Tenth Amendment argument put forward by the Tennessee General Assembly that, as a sovereign state, Tennessee should not be forced to pay for a program forced on it with questionable statutory authority by the federal government.

State Senator Mark Norris (R-Collierville) summarized the merits of the state’s Tenth Amendment lawsuit succinctly on Monday.

“The federal government must not do indirectly what it cannot lawfully do directly, and the Tennessee General Assembly must have the opportunity to approve, or disapprove, specific expenditures through the appropriation process,” Norris wrote in a letter to Gov. Haslam.


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