Trauma on Trumpcare

Update: Today, “President Donald Trump asked Republican senators not to leave town for their August recess without passing a health care reform plan that makes good on seven years of promises to repeal and replace President Barack Obama’s Affordable Care Act.”

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Since 2010, health care has been a top talking point for both general Americans and the American government.  Then, Obamacare, the Affordable Care Act, was enacted without a single Republican vote.  Now, the current iteration of Trumpcare, H.R. 1628, has passed the House and seeks to pass the Senate without the support of a single Democrat Senator.  Increasingly though, it is losing Republican support*, as Senators wrangle with the idea on Medicaid cuts and other issues.  (According to a recent report, the bill would cut Medicaid funding for children by at least $43 billion over 10 years.)

Throughout the country, articles continue to show the need for Medicaid for many Americans, often showcasing the needs of the brain injured.  The website MyCentralJersey.com (part of the USA Today network) highlights a 22-year-old and his mother who spoke to members of Congress about the ongoing trauma that the family deals with, caused by an accident that occurred when the boy was 18.  “Many families… will face major health care challenges.  It is important to protect Medicaid to allow these families to focus on their child’s care and recovery,” said the mother.  An article published on cleveland.com highlights the care of a severely brain injured man who lives in a nursing home, but whose family worries he won’t be able to stay at the facility with the proposed Medicaid cut.  A New York-based newspaper notes a 9-year-old girl who survived a horse-back riding accident with the financial support of Medicaid.

Yesterday, Trump expressed his frustration on Twitter with passing this bill.  “Most Republicans were loyal…,” he wrote, as a criticism of those Republicans who did not express support for the law.  However, this statement appears to show that Trump is looking for support to him and party, when he should be seeking support and loyalty towards the American people.

(Notably, Arizona Senator John McCain just underwent surgery yesterday to rid his head or his left eye, both have been reported, from blood clots.  While the specifics of his initial condition and the exact surgical procedure he underwent remains vague, it is concerning.  Because of McCain, the vote on this health care bill has been delayed.  It will be interesting, though, to see if McCain’s ordeal affects his views. )

* Yesterday, “Sens. Mike Lee (Utah) [a staunch conservative] and Jerry Moran (Kan.) issued statements declaring that they would not vote for the revamped measure.  They joined Sens. Rand Paul (Ky.) and Susan Collins (Maine), who also oppose it.”  A significant amount of other Republicans have also not declared their support.

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In America, Helmets ‘R Us

“Make sure you wear your helmet!”  Many remember their mother reciting this rule before a bicycle ride during their childhood.  In 1987, California became the first state to require children to wear helmets, though at the time it was only required for children under the age of 5.  In the past 30 years, many states and counties have taken California’s cue.  “At present, 21 states, and the District of Columbia, have state-wide laws, and more than 201 localities have local ordinances [requiring helmet use].”

While Ohio does not have a state law mandating helmet use, 24 Ohio cities have passed bicycle helmet laws.  At a meeting 7:00pm meeting tonight, Grandview Heights City Council’s safety committee is discussing whether the city should become the 25th city.  Specifically, Council members will be discussing legislation introduced by Council President Greta Kearns on June 5.  The proposed law states that, “children and teens caught riding without a helmet would be warned [on their first offense], but only if their parents can show proof of helmet ownership.”  Further offenses would include fines and charges.

In the United States each year, 218,000 children are treated in the Emergency Room for bicycle-related injuries.  In Ohio alone, that number is 6,200 children, while 1 in 6 of those children are treated for a traumatic brain injury.  The thought of this law and bicycle laws in general, is that, in time, helmets will become a childhood norm.  If so, doctors say it can reduce the risk of a traumatic brain injury by as much as 88 percent.

Legislature Acts to Put Paddling Out to Sea

“The use of any form of corporal punishment is prohibited in any public or secondary school.”  While this statement should be true everywhere, in 18 states the barbaric act of harsh corporal punishment (HCP) is still legal.  However, this exact quote comes from a bill that was presented for vote last month to the Louisiana State Legislature.  Sponsored by Barbara Norton (D-Shreveport), Louisiana House Bill 497 passed the Louisiana House Education Committee on April 26 with a vote of 6 – 5.  (Two Republicans and fours Democrats voted for it.)

Besides Louisiana, state law still permits harsh corporal punishment in Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas and Wyoming.  (It is prohibited in many school districts, though, largely because of fear of costly lawsuits.)  Specifically, the legality of HCP in some states comes under the protection of states’ rights and under the protection of particular school districts.  Some parents, some states and some school districts believe HCP to be an effective method of controlling a classroom.  The continued use of paddling can be evidenced by the fact that you can buy a paddle online.  (Some of the posted comments on the purchase page of this item are evidence that it is marketed for use on a child.)

The continued acceptance of corporal punishment in some schools is related to another horrifying statistic: “research shows that up to 90% of parents spank their children at least occasionally.”  The LA Times article, from which this statistic is taken, then showcases both the so-called PROs and CONs of mild HCP, spanking, with the divided points of view presented by different doctors.  The pro-spanking doctor states, “In reviewing all the literature, there’s one that leads to better outcomes, reduced defiance, reduced aggression in children, and that’s what I call backup spanking.”  On the other side, the doctor says that, “studies have shown that the more kids get spanked, the higher the child’s score on a post-traumatic stress test.”  More so, statistics demonstrate that spanking simply doesn’t work.  This article demonstrates that just as states and school districts have divided points of view regarding the use of corporal punishment, so do doctors, even with medical evidence at hand.

In addition to HB 497, this year, Louisiana Governor John Edwards declared, “Corporal punishment of children with disabilities should no longer be acceptable in Louisiana.”  In the 2015 – 2016 school year, for example, it is reported that 16% of students who were paddled had a disability.  (Unlike students without disabilities many disabled students are not in full mental control of their actions, particularly in their early years, such as preschool and kindergarten.)   The statement from the Governor specifically refers to HB 79, sponsored by Rep. Franklin Foil (R-Baton Rouge), which was also presented to the House this year at the same time as HB 497.  HB 79, which addresses students with disabilities including autism, intellectual disabilities, traumatic brain injury and others, passed the Committee unanimously.

The irony, for lack of a better word, is that though paddling and other forms of HCP may worsen the symptoms of an existing brain injury, it causes damage to the brain in those who are previously without such injury.  The title of a study conducted by the National Institute of Health provides evidence of this: “Reduced Prefrontal Cortical Grey Matter* Volume in Young Adults Exposed to Harsh Corporal Punishment.”  Specifically, beyond emotional and physical trauma, “HCP may be an aversive and stressful event for human beings that potentially alters the development trajectory of some brain regions in which abnormalities have been associated with major forms of psychopathology.”

* Grey matter in the brain is essentially necessary for everything.  “The grey matter includes regions of the brain involved in muscle control, and sensory perception such as seeing and hearing, memory, emotions, speech, decision making, and self-control.”  There is also grey matter in the spinal cord and, though it is not specifically mentioned, I’ve got to think that it is also compromised by HCP.

States Stop the Stop on Stipends

Veterans are provided with certain benefits from the country, as recognition for their time in service.  In 2000, the National Family Caregiver Support Program was created to provide, “grants to State and Territories… to fund a range of supports that assist family and informal caregivers to care for their loved ones at home for as long as possible.”  Though this program was initially directed towards, “adult family members of other [adult] informal caregivers… providing care to individual 60 years of age and older; adult family members or other [adult] informal caregivers… providing care to individuals of any age with Alzheimer’s disease and related disorders; grandparents and other relatives (not parents) 55 years of age and older providing care to children under the age of 18; and grandparents and other relatives (not parent) 55 years of age and older providing care to adults… with disabilities,” given how much they have given to this country, in 2010, the Caregivers and Veterans Omnibus Health Services Act , Public Law No. 111-163, was enacted nationally.  Public Law No.111-163 allows those who support veterans to apply for these benefits.  (This bill was sponsored by Sen. Akaka (D-HI) and cosponsored in a non-partisan way.)

Because this program relies on the state to determine who should be granted these benefits and how much this grant should be, based on the cost of living and the cost of medical care in the state, it is the states’ responsibility to keep the program running.  Recently, the Oregon VA decided to stop giving benefits to the caregivers of some veterans; 207 have been removed from the program, while 57 veterans are still participating.  However, on April 10, 2017, The Oregonian reported, “Portland VA to temporarily stop removing vets from caregiver program”.  Six members of Congressmen, all of whom happen to be Democrats, Rep. Kurt Schrader, Sen. Ron Wyden, Sen. Jeff Markley, Rep. Suzanne Bonamici, Rep. Earl Blumenauer and Rep. Peter DeFazio, put a stop to the stop.  (Though he did not participate in the halt of the stop, Republican Rep. Greg Walden of Oregon says he supports it.)

Though not yet enacted, the stop that some Oregon congressmen are trying to make is not unique to the state.  As of February 2016, thousands of veterans in Washington and Idaho had already been removed from the program.  However, as the title of these articles state, “Veterans’ caregivers lose VA stipends, struggle to understand why.”  The government says that the stipends given through this program were never meant to be permanent.  However, I can find no information in the text of the law that either confirms or negates this.  For many veterans with certain disabilities, such as some with TBI or PTSD, employment is simply not a possibility.  In fact, these articles profile specific veterans, with TBI and PTSD, for whom full recovery has not yet, and may never be, a medically-reasonable possibility.

North Dakota Brain Injury Advisory Council

This month (March 2017), the North Dakota Senate passed , “A bill for an Act to create and enact… a brain injury advisory council.”  Introduced in a bipartisan manner by Rep. D. Anderson (R-06) and Sen. Mathern (D-11), the bill passed the Senate unanimously.

According to the bill, the Council to be created will be comprised of at least one survivor, one family member of a survivor and others, both in government and outside of it.  Beyond the bill’s aforementioned mission, though, the text of the bill says little of what the Council is to do.

However, the North Dakota Brain Injury Advisory Council can take a cue from similar Councils in other states.  For example, in 2007, Washington State enacted House Bill 2055, which created the Washington Traumatic Brain Injury Strategic Partnership Advisory Council, “to bring together expertise from the public and private sector to address the needs and gaps in survivors.”  In 2003, Montana created a council, “to advise and make recommendations to the Governor on ways to improve and develop services [to aid] people with brain injuries and their families.”

It is heartening to see that another state has recognized the importance of its brain injured constituents.  It is just as important to see that it was done in a bipartisan manner, as brain injury doesn’t follow party lines.

SC Bill Seeks to Take Commission from Advisory to Action

During her time in office, South Carolina Governor Nikki Haley said, “[South Carolina] ‘absolutely’ has a responsibility to protect vulnerable adults just as much as it does to protect children.”  In accordance to South Carolina law, in this statement Haley is referring to individuals with intellectual disabilities, autism, traumatic brain injury and head and spinal cord injury.  The comparison of intellectually disabled adults to children may be offensive and ignorant, though common, but during her time in office there was a bipartisan attempt to take responsibility.  For example, during the last legislative year, Senator John Scott (D-Richland) filed a bill that, if it had passed, would have put the South Carolina Department of Disabilities and Special Needs (SCDDSN) in the governor’s cabinet.  This year, just before Haley resigned from her governorship to assume the role of United States Ambassador to the United Nations, state legislators continued their push to support vulnerable adults.  With the bipartisan support of such legislators as Republican Senator Harvey Peeler, the chairman of the Senate Medical Affairs Committee, Scott prefiled a bill similar to that of last year.

The mission of SCDDSN is to, “assist people with disabilities and their families through choice in meeting needs, pursuing possibilities and achieving life goals; and minimize the occurrence and reduce the severity of disabilities through prevention.”  Begun in 1996, the SCDDSN is currently led by seven people, one from each of the state’s seven Congressional districts, who are appointed by the Governor.  The Department has no identified head and some have called it, “the worst-run agency in the state.”  Newspapers also note the allegations of abuse and neglect of the exact people it intends to service.

To some, Scott’s bill seems to be the best available option.  As SCDDSN Commissioner Vicki Thompson says, “Right now, the commission acts like more of an advisory board to the agency, and [I don’t] see a willingness to change on the part of agency officials.”  A director, appointed by the governor, on the other hand, would oversee the department, serving as essentially the CEO and controlling the agency staff.  The commission would then officially become an advisory board.  According to SCDDSN Chairman Bill Danielson, “There are benefits to both the cabinet model and the commission model.”  The question is now which model do those in the state legislature and the South Carolina acting governor Henry McMaster see as best, as making the SCDDSN a cabinet position would mean more visibility, but visibly without action isn’t worth that much.

Richmond Rally Reacts to Rehabilitation Cuts

February 1 marked the 14th annual Brain Injury Awareness Day in Virginia.  Hosted by neurologist and State Delegate John O’Bannon, this day allows those affected by and/or advocating for brain injury to discuss their concerns and wants with their state legislators.  This year, the discussion specifically focused on the state government’s cuts (but not elimination) of funding for rehabilitation for brain injured individuals.  Because of this concern, “after meeting with legislators, dozens of survivors, advocates and caretakers of people with brain injuries held a rally Wednesday to call for improvements in services for disabled Virginians.”  What the government may not understand though, is that it takes rehabilitation, sometimes lengthy rehabilitation, to regain functionality following a brain injury, meaning that adequate state funding is necessary.  Increased functionality means increased employment, increased tax collections and less reliance on government-funded support and services.

Personal note:

In the article, Anne McDonnell, executive director of the Brain Injury Association of Virginia, is quoted as saying, “It is a rare privilege to watch a brain come back online.”  This statement implies that brain injury survivors are primarily non-functioning individuals.  This is highly offensive and simply not true.

Additionally, the article quotes a survivor who is involved with the Association, as saying, “Forty-two … I think I’m 42.”  By choosing to publish this quote, the author of this article is making light of a symptom of this survivor’s disability.  Additionally, I believe that this person, as with many brain injury survivors, has a general disbelief of his memory because he had so many memory problems immediately following his injury.  No one remembers everything.

Arizona Proposed Helmet Law Heads Nowhere

On Wednesday, January 18, the Arizona House Transportation and Infrastructure Committee made a unanimous call against House Bill 2046, a “helmet law” proposed by Rep. Randall Friese.*  Specifically, the bi-partisan committee voted against a law that would require adults driving motorcycles, all-terrain vehicles or motor driven cycles to wear helmets or to pay a fee into a special trauma-injury fund.

Regarding this rejection, many of the bill’s critics said that what Arizonians need is simply better training.  Another critic, “Rep. Noel Campbell, R-Prescott, who chairs the [Committee], said he personally wears “every piece of equipment you can get on” when he rides his motorcycle. But he said a better legislative approach would be incentives for riders to protect their heads, rather than penalties for those who do not.”  I disagree, rewarding someone just because they are “safe cyclists” is not the answer.  (Should you really be rewarded for not hitting another vehicle?)  The idea proposed by other critics, better and more thorough training for cyclists, may be a better solution.

Note that this is not the first time that the Arizona House has rejected a helmet law, proposed by Friese.  “When [Friese] introduced this bill two years ago, the first thing [he] heard was, ‘It is my right to ride my bike without my helmet.”  However, in his view, “I don’t believe it’s a right. I believe it’s a privilege.”  Whatever it may be, a right or a privilege, riding unhelmeted is irresponsible.

* Rep. Randall Friese, D-Tucson, definitely has a different perspective than many members of the Transportation and Infrastructure Committee and of the State Assembly at large.  Friese is a trauma surgeon.  Presumptively, he has operated on head-injured motorcyclists.  He has seen first-hand what a severe motorcycle accident can do to the brain and to the person.  Having directly viewed the brain after such an incident definitely gives him a unique, and more cautious, perspective.

Michigan Helmet Law Revision May Save Lives, But Hurts Heads

“Make sure you wear your helmet.”  Many people recall this statement from their parents when they said that they were going outside to ride their bicycle.  As an adult, the government plays the role of a parent about helmet safety issues.  While 3 states have no law about helmet use for motorcycle riders, “28 states require some riders to wear helmets; and 19 states and the District of Columbia require all motorcyclists to wear them.”  In April 2012, Michigan law changed from requiring all riders to wear helmets to merely some.  The purpose of the loosening of the helmet law was to increase tourism to the state.  Unfortunately, all it increased was the number of head injuries.

As the Michigan Secretary of State says, “Michigan law now allows motorcyclists to decide for themselves…”  Granted, there are certain legality conditions that must be met, but for most cyclists, helmets are optional.  Many may find it surprising and positive that some studies show that the revision of the Michigan helmet law has had no effect on, or even lessened the number of motorcycle-related fatalities. However, the law has resulted in a 14% increase in head injuries.  Specifically, reported mild concussions fell by 17%, “while the proportion [of injuries] due to skull fractures increas[ed] 38% during the same period.”

Ultimately, whether or not the government should be telling you to wear a helmet is debatable.  However, there can be no debate on the fact that any law that increases the chance of a head injury is negative.