Refugee Public Health Controversy in Michigan

Syrian_refugees Alexander ZemlianichenkoAP
Alexander Zemlianichenko/AP

Another public health controversy is hitting the state of Michigan.

This time the problem is not the lead in the drinking water of Flint, Michigan, an issue that remains unresolved more than a year after it was first identified.

Instead, it concerns the reporting and monitoring of the health status of the more than 4,000 refugees who were resettled in the state in FY 2016, the more than 20,000 who arrived in the preceding decade, and the 5,600 the Obama administration wants to bring in to the state this coming fiscal year.

Non-profit refugee resettlement agencies in Michigan and the Michigan Department of Health and Human Services are not complying with refugee health reporting and monitoring requirements of the Refugee Act of 1980, an attorney familiar with the federal refugee resettlement program tells Breitbart News.

But a spokesperson for the Michigan Department of Health and Human Services (MDHHS) says the state reads the law differently.

“The Refugee Act of 1980 does not say that states must collect and maintain latent TB infection rates of recently arrived refugees,” Bob Wheaton, director of communications for MDHHS tells Breitbart News.

“The Refugee Act of 1980 does not say that states must monitor the health status of refugees who tested positive for latent TB and ensure that they receive treatment for that condition,” he adds:

MDHHS has contracts in place so refugees can receive a health screening within 90 days of their date of entry into the U.S. However, latent TB is not a reportable condition under the Public Health Code and treatment is determined by the physician. Under the Public Health Code, only active TB is a mandatory reported condition in Michigan.

Wheaton admits that the state does not maintain a database of latent TB infection rates among arriving refugees on an aggregate level.

Breitbart News asked MDHHS for data on LTBI infection rates based on the entire population of refugees screened, not just the small group with B1, B2, and B3 notifications.

“We do not have that data,” MDHHS spokesperson Wheaton told Breitbart News.

Breitbart News asked Elizabeth Yore, former “General Counsel at the Illinois Department of Children and Family Services for 8 years and the General Counsel at the National Center for Missing and Exploited Children” to unravel these two competing views of the statutory requirements of the Refugee Act of 1980.

Yore tells Breitbart News:

The Refugee Act of 1980 specifically directs states to identify, treat and monitor refugees with medical conditions that affect the public health. Latent TB is a serious medical condition which requires treatment and monitoring to safeguard that the refugees are complying with medical treatment so that active and infectious TB does not manifest in the patient. The purpose of this section of Refugee Act is to ensure that potential infectious diseases are strictly monitored, treated, and contained. An outbreak of TB endangers the public health, safety and welfare of the State, and elsewhere.

This is another potential Flint Water Crisis. By ignoring and flaunting the federal law which addresses the public health concerns of the State, the MDHHS is recklessly playing roulette with the public health and safety of its citizens. Such a imprudent and cavalier attitude toward public health appears to be endemic in Michigan. Apparently, Michigan health officials haven’t learned that public health and safety demands the utmost vigilance and diligence for citizens, families and, especially children.

By not monitoring and tracking latent TB infected refugees in Michigan, MDHHS is endangering public health and creating a new category of “sanctuary states” which are petri dishes for infectious diseases.

The Refugee Act of 1980 was sponsored by the late Sen. Edward Kennedy (D-MA). It  specifies that information about individual refugees who test positive for latent tuberculosis infection is transmitted to local county health departments upon diagnosis.

But Michigan resettlement agencies, including Samaritas (formerly known as Lutheran Immigration and Refugee Service of Michigan), and contracted refugee health screening services, including the Arab American Chaldean Council (contracted by MDHHS to conduct refugee health screenings in Oakland, Macomb, and Wayne Counties), are not providing this legally required data to county health departments.

Latent TB infection, poses a public health risk, as Breitbart News reported previously:

The latent tuberculosis (TB) infection rate among arriving refugees arriving in the state of California during 2014 is at the lower end of all reporting states. Florida has a similar rate (12 percent), and Texas (15 percent) is slightly higher. At the highest end are Vermont (35 percent) and Tennessee (27 percent).

Many states, however, fail to collect or report either latent TB infection rates or the number of active TB cases diagnosed among recently resettled refugees.

High latent TB infection rates among resettled refugees pose a public health risk of active TB in communities in which they live, according to a 2013 study from the University of California at San Diego.

The latent TB infection rate among the general population is about four percent.

California is just one of seven states that appear to be fully compliant with the refugee health reporting and monitoring standards specified by the Refugee Act of 1980. The other compliant states are Texas, Florida, Minnesota, Utah, Indiana, and Arizona.

But the state of Michigan refuses to acknowledge that latent TB infection is a public health risk, as defined by the Refugee Act of 1980.

As Breitbart News reported previously, 19 refugees have been diagnosed with active TB in Michigan during the past six years. The state does not know what percentage of recently resettled refugees test positive for latent TB infection, and, the attorney familiar with the federal refugee resettlement program tells Breitbart News, it should know and report that information to the public.

Attorney Elizabeth Yore agrees. “Michigan parents, out of an abundance of concern for the health of their children, should demand from MDHHS a system of intensive tracking and monitoring of latent and active TB cases of resettled refugees.”

Breitbart News asked MDHHS spokesperson Wheaton if he consulted with legal counsel prior to asserting the Refugee Act of 1980 does not apply to Michigan’s reporting and monitoring requirements.

“I consulted with appropriate MDHHS staff with the appropriate expertise to answer your questions,” Wheaton responds.

When informed that attorneys familiar with the Refugee Act of 1980 tell Breitbart News that MDHHS staff are wrong on the law, Wheaton brushed that news off.

“Thanks for the opportunity, but our initial response should suffice for us. I’ll look forward to seeing who the attorneys are and what they have to say,” he said.

The attorney familiar with the federal refugee resettlement program says that is a huge problem.

“Under the Refugee Act of 1980, refugee resettlement contractors are required to ‘assure that refugees, known to the agency as having been identified . . . as having medical conditions affecting the public health and requiring treatment [such as active and latent TB], report to the appropriate county or other health agency upon their resettlement in an area.’ See (8 US Code 1522 (4) (B) (D) and (7) (C)),” an attorney familiar with the federal refugee resettlement program tells Breitbart News.

“Nor have they monitored the health status of refugees so identified, also a requirement of the Refugee Act of 1980,” the attorney adds.

“At the very least, MDHHS should be aware of the CDC guidelines, which the Michigan Advisory Committee for Elimination of TB cited in its 2012 recommendations,” the attorney notes.

“The CDC has established guidelines for the domestic evaluation of newly-arrived refugees for TB, ” the recommendations note, with a link to the CDC domestic evaluation of refugees for TB which says among other things:

The primary goal of the domestic refugee medical screening evaluation for TB is to identify individuals with latent TB infection (LTBI) or TB disease, to facilitate timely treatment and control.

The Michigan Department of Health and Human Services has a rocky recent past.

Earlier this month a former state epidemiologist pleaded guilty to a misdemeanor for actions related to the Flint public water drinking crisis.

As the Detroit Free Press reported:

A former director with the Michigan Department of Health and Human Services pleaded no contest today to a misdemeanor charge in the Flint water crisis.

As part of the plea deal reached with Corinne Miller, the former director of the Bureau of Disease Control, Prevention and Epidemiology, two felonies were dismissed, including misconduct in office. She pleaded no contest to willful neglect of duty by a public officer. As part of the agreement, Miller, who retired from the department in 2016, must cooperate with the Michigan Attorney General Office’s investigation into the water crisis and provide truthful testimony.

“I wouldn’t have put this deal together unless we knew what she could do,” Todd Flood, the lawyer spearheading the prosecutions, said after the hearing. He declined to elaborate.

The plea agreement includes references to “Suspect 1” and “Suspect 2,” and says Miller was asked in January 2015 to provide a report about an outbreak of Legionnaires’ disease in the Flint area that started after the city changed its water supply from Lake Huron to the Flint River. She gave both people information about it, court documents say, but officials haven’t revealed the identities of the two people.

Miller, who didn’t speak in court other than to briefly answer questions from the judge, is the second defendant to reach a plea deal among the nine charged in connection with Attorney General Bill Schuette’s investigation.

Though officials with the MDHHS and resettlement agencies appear to be unconcerned about serious legal arguments presented that they are failing to comply with the Refugee Act of 1980, Oakland Michigan County Executive L. Brooks Patterson has a different view.

Last week, Patterson said Oakland County intends to sue the federal government and ask for a temporary injunction that will immediately stop the flow of more than 1,000 refugees a year into Oakland County, on grounds that the health reporting and monitoring requirements, as well as the consultation requirements of the Refugee Act of 1980 are being violated.


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