U.S. vaping-related deaths rise to 42, cases of illness to 2,172

U.S. vaping-related deaths rise to 42, cases of illness to 2,172
(Reuters) – U.S. health officials on Thursday reported 2,172 confirmed and probable cases and 3 more deaths from a mysterious respiratory illness tied to vaping, taking the death toll to 42, so far this year.

Last week, the Centers for Disease Control and Prevention reported 2,051 confirmed and probable U.S. lung injury cases and 39 deaths associated with use of e-cigarettes, or vaping products.

As of Nov. 13, 42 deaths have been confirmed in 24 states and the District of Columbia, the agency said. (http://bit.ly/2NrLYXW)

Health officials last week also dubbed the discovery of Vitamin E acetate — believed to be used as a cutting agent in illicit vaping products containing marijuana components — in all lung samples from 29 patients as a breakthrough in their investigation.

Investigators have not linked the cases to any specific product or compound, but have pointed to vaping oils containing THC, the psychoactive ingredient in marijuana, as being especially risky.

(Reporting by Manas Mishra and Saumya Sibi Joseph in Bengaluru; Editing by Shounak Dasgupta)

Pompeo ‘deplored’ the death toll at protests in phone call with Iraqi PM: State Dept

Pompeo ‘deplored’ the death toll at protests in phone call with Iraqi PM: State Dept
WASHINGTON (Reuters) – U.S. Secretary of State Mike Pompeo in a phone call with Iraqi Prime Minister Adel Abdul Mahdi “deplored the death toll” among protesters due to the crackdown of the Iraqi government and urged him to take immediate steps to address demonstrators’ demands, State Department spokeswoman Morgan Ortagus said on Tuesday.

Iraqi security forces on Monday shot dead two protesters in the city of Nassiriya, bringing to 300 the number of people killed since protests against political corruption, unemployment and poor public services erupted in Baghdad on Oct. 1 and spread to the southern Shi’ite heartlands.

“The Secretary deplored the death toll among the protesters as a result of the Government of Iraq’s crackdown and use of lethal force, as well as the reports of kidnapped protesters,” Ortagus said in a statement.

The government has failed to find an answer to the unrest among mostly unemployed young people who see no improvement in their lives even in peacetime after decades of war and sanctions.

“Secretary Pompeo emphasized that peaceful public demonstrations are a fundamental element of all democracies,” Ortagus said and added that Pompeo urged Mahdi to address the protesters’ grievances by enacting reforms and tackling corruption.

The unrest is the biggest and most complex challenge to the Iraqi political order since the government declared victory over Islamic State two years ago.

(Reporting by Lisa Lambert and Humeyra Pamuk; Editing by Chris Reese and Lisa Shumaker)

IOM suspends some Ebola screening after three aid workers killed in South Sudan

IOM suspends some Ebola screening after three aid workers killed in South Sudan
By Denis Dumo

JUBA (Reuters) – The U.N. migration agency has suspended some screening services for Ebola after three of its aid workers were killed in South Sudan, the latest deadly incident involving relief staff in the violence-ridden country.

In a statement, the International Organization for Migration said the workers – two men and one woman – were hit by crossfire during clashes between rival armed groups in the country’s central Equatoria region.

It said the IOM had stopped screening for Ebola at five border points between South Sudan, Uganda and Democratic Republic of Congo, where an ongoing outbreak of the haemorraghic fever has killed thousands of people.

The dead woman’s four-year-old son was abducted along with another local female IOM volunteer during the armed clash, the IOM said. Two other male volunteers were injured, including one who is recovering from a gunshot wound.

Humanitarian workers are often targeted by rebels operating in South Sudan, which has been in the grip of war that first broke out in late 2013 between soldiers allied to President Salva Kiir and those of his former deputy Riek Machar. Last year, 10 aid workers went missing in Yei, in the same region.

“We …reiterate that humanitarians and civilians are not and should never be subjected to such heinous acts of violence – we are not a target,” IOM Director General António Vitorino said.

It was not clear who was behind the latest fighting.

In the past, government forces have clashed in the region with fighters from the rebel National Salvation Front, led by renegade former General Thomas Cirillo Swaka, who is not a party to a peace deal signed last year by Kiir and Machar.

Lul Ruai Koang, the government’s military spokesman, said that on the day of the attack Cirillo’s fighters had targeted a government position, and that one soldier was killed along with nine from Cirillo’s side.

“If they (National Salvation Front) went and killed the aid workers, this is what I do not know. But the attack on our defense positions didn’t involve any humanitarian workers,” Koang said.

The National Salvation Front was not immediately reachable to comment on the killings.

(Reporting by Denis Dumo with additional reporting and writing by George Obulutsa in Nairobi; Editing by Mark Heinrich)

UK police arrest man and woman for human trafficking over truck deaths

UK police arrest man and woman for human trafficking over truck deaths
By Peter Nicholls

GRAYS, England (Reuters) – Police investigating the deaths of 39 people in a truck near London said they had arrested a man and a woman on Friday on suspicion of human trafficking amid signs that some of the dead may be Vietnamese.

As forensic experts began the process of identifying the victims, a human rights activist said at least one of them might have been a Vietnamese woman.

Police have said they believe the dead were Chinese but Beijing said the nationalities had not yet been verified.

“We hope that the British side can as soon as possible confirm and verify the identities of the victims, ascertain what happened and severely punish criminals involved in the case,” Chinese Foreign Ministry spokeswoman Hua Chunying told a daily news briefing.

Police said they had detained the man and woman, both aged 38, in Warrington, northwest England, on Friday on suspicion of conspiracy to traffic people and of 39 counts of manslaughter.

The 25-year-old truck driver remains in custody after being arrested on suspicion of murder following the discovery of the bodies in the back of his refrigerated truck in the early hours of Wednesday.

He has not been formally identified but a source familiar with the investigation named him as Mo Robinson from the Portadown area of Northern Ireland. Detectives will decide later whether to charge him with an offense, release him or ask a court for more time to question him.

The victims – 31 men and eight women – are being moved to a hospital mortuary from a secure location at docks near the industrial estate in Grays about 20 miles (30 km) east of London where the bodies were found.

Post-mortem examinations were beginning to determine how exactly they died while forensic experts sought to identify the deceased.

Hoa Nghiem from Human Rights Space, a civic network based in Vietnam, said at least one of the deceased might have been Vietnamese.

Pham Thi Tra My, 26, sent a text message to her mother saying she could not breathe at about the time the truck container was en route from Belgium to Britain, Hoa said.

“I’m sorry Mom. My path to abroad doesn’t succeed. Mom, I love you so much! I’m dying bcoz I can’t breath … I’m from Nghen, Can Loc, Ha Tinh, Vietnam … I am sorry, Mom,” the message said according to Hoa.

She said Tra My had gone to China and was planning to reach England via France.

“Our contact is getting more alerts that there could be more Vietnamese people in the truck,” Hoa said on Twitter.

VietHome, an organization for the Vietnamese community, said it had received news from 10 families that their loved ones were missing. Hanoi’s London embassy was coordinating with British police, the official Vietnam News Agency (VNA) reported.

For years, illegal immigrants have attempted to reach Britain stowed away in trucks, often from the European mainland. In 2000, 58 Chinese were found dead in a tomato truck at the port of Dover.

BRITAIN ‘HAS NOT FULFILLED RESPONSIBILITY’

China’s Global Times, which is published by the ruling Communist Party’s official People’s Daily, said in a Friday editorial that Britain should bear some responsibility for the deaths.

“It is clear that Britain and relevant European countries have not fulfilled their responsibility to protect these people from such a death,” the widely read tabloid said.

It added that Britain appeared not to have learned its lesson from the Dover incident two decades ago.

The police investigation is focused on the movement of the trailer prior to its arrival at Purfleet docks near Grays little more than an hour before the bodies were found, and on who was behind the suspected human trafficking.

Irish company Global Trailer Rentals said it owned the trailer and had rented it out on Oct. 15. The firm said it was unaware of what it was to be used for.

The refrigeration unit had traveled to Britain from Zeebrugge in Belgium and the town’s chairman, Dirk de Fauw, said he believed the victims died in the trailer before it arrived in the Belgian port.

The Times newspaper reported that GPS data showed the container had arrived at the Belgian port at 2.49 p.m. local time on Tuesday before later making the 10-hour sea crossing to Britain.

Police said the cab unit of the truck was driven over from Dublin on Sunday, crossing the Irish Sea by ship and entering Britain in North Wales. It picked up the trailer in Purfleet shortly after midnight on Wednesday.

The National Crime Agency, which targets serious and organized crime, said it was helping the investigation and working urgently to identify any gangs involved.

The head of the Road Haulage Association said traffickers were “upping their game” and closer cooperation with European nations was needed, although that may be complicated by Britain’s planned exit from the European Union.

(Additional reporting by Ben Blanchard in Beijing and Khanh Vu and Phuong Nguyen in Hanoi; Writing by Michael Holden; Editing by Guy Faulconbridge, Frances Kerry and Hugh Lawson)

Deaths, bad outcomes elude scrutiny at Canada’s indigenous clinics

Deaths, bad outcomes elude scrutiny at Canada’s indigenous clinics
By Allison Martell

TORONTO (Reuters) – Ina Matawapit was barely conscious – intoxicated and suffering from a blow to the head – when police drove her to the North Caribou Lake clinic in Ontario, Canada, one summer evening in 2012.

The nurse at the federal government-run clinic, the only source of emergency care in this remote indigenous community, told the officers the 37-year-old could sober up in jail, according to testimony at a 2018 inquest. Minutes after leaving the clinic, the police sped back. Matawapit had no pulse and could not be revived.

At the inquest, the nurse testified that in sending Matawapit on to jail, she had been following a standard protocol for intoxicated patients in the northern reserves. Government officials testified there was no such thing.

The coroner found that in the nearly six years between the death and the inquest, there was no evidence of any formal review of the case “or any learning from the events of that evening” akin to typical procedures in hospitals or emergency rooms. Matawapit’s death, attributed to heart disease, likely would have passed under the radar but for the fact that she died in police custody, which made the inquest mandatory.

Over at least nine years, the Canadian federal government has not consistently tracked, let alone investigated, poor outcomes at clinics on indigenous reserves, according to a Reuters analysis of documents, including internal reports and meeting notes obtained through public records requests.

Record-keeping on deaths and other critical incidents at the clinics, which provide basic and emergency care to about 115,000 people, has been erratic and fragmented, Reuters found. The incidents often are detailed in separate provincial computer systems, when they are tracked or reported at all.

As a result, there is no way for the federal government to know how often patients die or suffer injury at the clinics or how that compares to the rest of the Canadian health system.

The federal government’s First Nations and Inuit Health Branch (FNIHB), which funds 79 clinics and manages 50 of them, is hampered in identifying potentially harmful patterns and preventing future mistakes, documents and interviews with medical experts indicate.

Whether turning away apparently intoxicated patients in the northern reserves – described in the coroner’s verdict as the “northern protocol”- has been a widespread practice is difficult to say. Reuters was able to find one other similar death, detailed in Manitoba police records, that occurred five months after Matawapit’s. The federal government enacted a policy saying it was “not appropriate” to hold intoxicated patients in cells – but only after last year’s inquest brought the issue to light.

Reuters’ findings come as the country is in the midst of a public reckoning with the legacy of settler colonization, a hotter issue today than in nations such as the United States and Australia where European settlers also displaced local peoples.

With an indigenous population that is growing and gaining political clout, Prime Minster Justin Trudeau came to power in 2015 promising “reconciliation” with aboriginal people. Reduced to a minority government in this week’s election, he needs the support of other parties to govern and will face pressure from the left to address poverty, poor housing and health problems that are especially acute on remote reserves.

It will not be an easy task. Even reviewing critical health care incidents could be a challenge because of the multiple jurisdictions and providers involved, said Michael Green, a professor at Queen’s University who was once chief of staff at a small northern hospital that often received patients from clinics in indigenous communities.

But “without review, there’s no opportunity to learn and make the system safer for everybody,” he said.

Staff at FNIHB, part of Indigenous Services Canada, say they strive to provide the best possible care and have been working on a replacement reporting system, slated to roll out next year.

The effort, which documents show began in 2014, has been planned behind closed doors and has not previously been reported, although pilot programs are running in Manitoba and Alberta.

Documents reviewed by Reuters indicate the system is designed to provide national case tracking and a consistent process for investigating and following up on cases.

Robin Buckland, executive director of primary healthcare at FNIHB, said the current system is “not a bad policy” but the agency is working to build an environment in which staff members can learn.

“It’s taken a long time,” she said. “But we want it to be right, and we want to implement it well.”

Reuters was not able to reach the nurses involved in treatment described in this story.

“We truly believe that nurses are working hard to deliver the best health care possible, under difficult work conditions,” said Debi Daviau, president of the Professional Institute of the Public Service of Canada, which represents permanent staff nurses and other civil servants.

‘SECOND-CLASS CITIZENS’

For years, indigenous communities have complained about poor treatment on remote reserves, which are often hundreds of miles from top-tier or specialized medical services in major cities. Matawapit died in a community more than 300 km (186 miles) from the nearest major highway.

For a map of reserves see: https://tmsnrt.rs/32uE3yk

These federally funded clinics, usually called nursing stations, struggle to retain nurses, often filling gaps with the help of private staffing agencies.

Services there need more government scrutiny, not less, some critics say.

“We are treating members of the First Nations communities as second-class citizens,” said Emily Hill, a senior staff lawyer with Aboriginal Legal Services, which represented the Matawapit family at the inquest. “This is a large government health service. You would expect there to be layers of oversight and accountability.”

Documents reviewed by Reuters show FNIHB staffers have repeatedly called for a modern reporting system for poor or unexpected outcomes.

The FNIHB started to track critical incidents in 2006. By 2010, however, a federal audit found that “monitoring and analysis at both the national and regional level is not occurring.”

Four years later, a FNIHB working group said that a common national policy was needed with “clear processes for reporting and tracking” incidents, according to meeting notes reviewed by Reuters.

In 2016, an internal report by a member of the working group looked at how other public organizations, including federal prisons, reviewed outcomes. Every policy was found to be more “robust” than the one at FNIHB.

The report, reviewed by Reuters, said that while some patient safety incidents had been recorded in a national database between 2006 and 2014, regions had stopped using it because of the difficulty in collecting data.

Federal policy focused mainly on nurses’ well-being, not patients’, the report said.

The nurse at the Matawapit inquest illustrated that point, testifying that a debriefing after the patient’s death was geared “more to how we were feeling as opposed to what we did.”

A SIMILAR DEATH

On November 28, 2012, the Royal Canadian Mounted Police in God’s Lake Narrows, Manitoba, responded to a report that Tracy Okemow, 31, was drinking and threatening suicide. Police found her next to two empty pill bottles labeled “metformin,” a diabetes drug, according to a police review of the incident seen by Reuters. She agreed to go to the local nursing station.

The nurses told officers they had consulted with a doctor off the reserve who felt her “consumption of medication was not of concern and she could be incarcerated until sober,” according to the police report.

Okemow spent the night in jail. A witness later told police that she seemed to be in agony. In the morning, she was flown to a Winnipeg hospital, where she died the next day of metformin toxicity, the report said.

There was no inquest or federal inquiry. “In the case of Ms. Okemow, the death occurred outside of a federally operated facility – therefore FNIHB did not undertake a formal review,” Indigenous Services Canada said in a statement.

Off reserve, healthcare is under provincial jurisdiction.

‘THEY BRUSH US OFF’

The federal government has reviewed some patient deaths, often after they draw media attention. Documents reviewed by Reuters show officials have found serious systemic problems, including nurses who are stretched thin and do not always appreciate the seriousness of patients’ symptoms.

After two children died from complications of strep infections in 2014, an internal review looked at a “sampling” of young people who had died, and called for better recruitment and retention of nurses, as well as more physician services.

A 2018 review looked at a 15-month-old toddler seen on a Saturday night for a seizure and infections. The nurse on duty did not consult a doctor, and the child died the next day. The report called for better oversight of nurses, as well as changes to shifts and staffing to address fatigue.

FNIHB’s Buckland said the agency is working to improve hiring and retention amid a global shortage of healthcare workers.

In Manitoba, the family of Tyson McKay is suing the federal government, alleging that the 32-year-old man died of a heart attack 31 hours after visiting a clinic complaining of chest pain in 2015. The suit alleges the nurse did not perform the appropriate tests that could have diagnosed his condition.

In a court filing, the government said a staffing agency was responsible for ensuring the nurse was qualified. The staffing agency defended its care and referred questions to the government.

Kelvin McKay, Tyson’s 41-year-old brother, has been going to the clinics since childhood. He said he sees a pattern.

“Nurses come in and out of our community, and they fail to take the time to get to know our people, and they think we come in with fake illnesses. They brush us off. And that’s not how it’s supposed to be.”

For a graphic on clinics on indigenous reserves often distant from major cities, click https://graphics.reuters.com/CANADA-HEALTH-NURSINGSTATIONS/0100B2H81S6/canada-map.jpg

(This story refiles to add dropped word in paragraph nine)

(Additional reporting by Rod Nickel in Winnipeg; Editing by Denny Thomas and Julie Marquis)

‘It is time to stop vaping’: Kansas reports sixth U.S. death linked to mystery illness

By Matthew Lavietes

(Reuters) – A Kansas resident was the sixth person to die in the United States of a mysterious respiratory illness related to vaping, state officials said on Tuesday, as public health officials scrambled to understand a nationwide health problem.

“It is time to stop vaping,” Kansas State Health Officer Dr. Lee Norman Norman said in a statement. “If you or a loved one is vaping, please stop.”

U.S. public health officials are investigating 450 cases of vaping-related lung illness across 33 states and one U.S. territory. The nationwide investigation led by the U.S. Centers for Disease Control and Prevention and the U.S. Food and Drug Administration has not linked the illnesses to any specific e-cigarette product.

Many of the reported illnesses involved vaping products, including cannabis products, containing vitamin E acetate, an oil derived from vitamin E that can be dangerous if inhaled. The vaping industry has blamed the surge in the contagion on black market products, but health officials have yet to rule out any vaping devices as a potential cause.

“We agree with the FDA — if you don’t want to die or end up in a hospital, stop vaping illegal THC oils immediately,” said a spokesman from the American Vaping Association. “If you’re an adult smoker or ex-smoker who vapes store-bought nicotine products, don’t listen to the activists who would rather you inhale deadly smoke than vape.”

Symptoms among the reported cases included shortness of breath, fever, cough and vomiting. Additional indicators have included headache, dizziness and chest pain.

To date, Kansas has six cases associated with the outbreak. Health officials disclosed that the individual who died was over the age of 50 and had a history of underlying health issues, according to the statement. No other information was provided to protect patient confidentiality.

“Our sympathies go out to the family of the person who died,” Governor Laura Kelly said in the statement. “I urge Kansans to be careful. Don’t put yourself in harm’s way, and please follow the recommendations of public health officials.”

The American Medical Association on Monday urged Americans to stop using electronic cigarettes of any sort until scientists have a better handle on the illnesses.

(Reporting by Matthew Lavietes in New York; Editing by Scott Malone and David Gregorio)

Special Report: Death and politics roil a Georgia jail

FILE PHOTO: The Chatham County Jail sits at sunset in Savannah, Georgia, U.S., May 2, 2019. REUTERS/Shannon Stapleton

By Ned Parker, Jason Szep and Linda So

SAVANNAH, Ga. (Reuters) – In the summer of 2016, Georgia’s Chatham County hired jail monitor Steven Rosenberg with a mission: scrutinize the county jail’s healthcare services after a string of deaths.

In the previous 30 months, seven inmates had died at the Chatham County Detention Center, shaking public confidence. The last healthcare provider lost its contract in June 2016 after some of its own staff accused it of improper practices.

Chatham County sought a fresh start, signing a multiyear contract worth $7 million annually with a small Atlanta company, CorrectHealth LLC. The county wanted to know whether the new provider was taking the steps needed to prevent deaths.

But after several trips to the jail that summer through winter, Rosenberg’s team delivered four scathing reports. They described staff shortages, unclear health guidelines and failures to give inmates prescribed medications. Such failings, they warned, could trigger “potential loss of life.” Indeed, that September, six weeks before the second report was issued, an inmate strangled himself with a telephone cord. The death came after the monitors warned that the facility lacked written policies for suicidal inmates.

In late December, Rosenberg pressed CorrectHealth and Quick Rx, the jail’s pharmacy operator, to open their books for inspection; his firm was hired to assess the company’s compliance with the contract and tally penalties for shortcomings. Before the day was out, the county sheriff barred Rosenberg from the detention center.

Both companies were politically connected in Savannah. CorrectHealth, and its president’s wife had donated $5,000 to the election campaign of Chatham County Sheriff John Wilcher. CorrectHealth also had hired a state senator to run the jail’s dental clinic. And pharmacy operator Quick Rx was owned by a powerful member of the Georgia House of Representatives.

Rosenberg’s team was allowed back three weeks later, but the skirmish was the start of a standoff between the monitor on one side, and county and company on the other. Within a year, the county terminated the monitor’s contract, at the sheriff’s request, and waived $5 million in fines the monitor had recommended imposing on CorrectHealth. Wilcher rebuffed a plan to hire a new provider.

Instead, commissioners in June 2018 handed CorrectHealth a new three-year deal worth $22 million. During the bidding process, Reuters found, CorrectHealth shared inflated budget costs with its competitors, allowing it to make a cheaper offer.

FILE PHOTO: An inmate on suicide watch sits while prison officers talk to him at the Chatham County jail in Savannah, Georgia, February 21, 2019. REUTERS/Shannon Stapleton

FILE PHOTO: An inmate on suicide watch sits while prison officers talk to him at the Chatham County jail in Savannah, Georgia, February 21, 2019. REUTERS/Shannon Stapleton

The Chatham County Detention Center’s troubles offer a look into the challenges American communities face in holding accountable the private companies that have been entrusted with managing healthcare services at a growing number of jails and prisons. The failed reform effort in Savannah also speaks to the power of local politics, in a county where two state officials had a piece of the jail medical contract.

After the county terminated Rosenberg’s contract in October 2017, medical and guard staff shortages persisted and medicines continued to go missing. Six inmates have died – five by their own hands – since CorrectHeath took over three years ago.

Wilcher said in a February interview he was “happy” with CorrectHealth. He declined to answer all follow up questions and referred Reuters to the county attorney, who did not reply.

CorrectHealth did not respond to interview requests or questions sent in writing. Quick Rx told Reuters it won the work on merit, not politics.

The United States incarcerates more prisoners than any other wealthy democracy, and an increasing number of local jails, housing over 700,000 inmates, contract with for-profit healthcare companies. The companies offer local governments ways to control jail spending and manage a notoriously unhealthy population.

Yet the for-profit industry operates with little local or national oversight, monitored only if localities volunteer to seek review by non-government accrediting groups. Despite the Georgia jail’s continued problems with suicides, it received coveted accreditations from a national industry body for inmate medical and mental health care.

“Healthcare providers do what they want to do. There’s often nobody monitoring the contract,” said U.S. Justice Department consultant Steve Martin, a former Texas Corrections Department general counsel who has inspected some 500 prisons and jails.

FRIENDS IN HIGH PLACES

Carlo Musso, an emergency room doctor who founded CorrectHealth in 2000, has built an operation that now holds 41 contracts at jails across Georgia and Louisiana, with 2017 operating revenue of nearly $45 million. He is also a generous donor to politicians and sheriffs and a fundraising stalwart for the Georgia Sheriffs Association. Musso, his wife and companies donated $363,000 over a dozen years to Georgia politicians seeking state office, records show.

In Chatham County, Musso’s chance came in August 2015 when the jail’s healthcare contract opened for bidding. The relationship between the county and the jail’s previous medical provider, Corizon Health Inc, had deteriorated after a string of deaths, straining their ability to work together and ultimately leading to its loss of the contract. In a letter to the county, Corizon said it had been made a “scapegoat” for problems.

Musso promised sweeping change at the Chatham County Detention Center.

That November, the county sheriff at the time died of cancer, triggering a special election. Wilcher, a 40-year veteran of local law enforcement, won in March 2016. Pitching himself as a reformer, he vowed to “make the sheriff’s office great again.”

In June 2016, CorrectHealth won the deal, taking over the jail’s healthcare that August. The county viewed the new tender as a way to improve jail medical care. “The old contract really had no teeth in it,” said Roy Harris, the acting sheriff before Wilcher was elected.

The new contract set requirements for medical staffing and fines for failing to meet them. Intake screenings had to be completed within four hours or the company faced a $500 penalty per violation. Inmates had to receive medications within two hours of their prescription schedule; violations brought $100 fines per case.

As CorrectHealth won the job, Musso promised to retain the jail’s pharmacy firm, Quick Rx, owned by Ron Stephens, a titan of the state Republican Party and two-decade veteran of the Georgia House of Representatives.

Quick Rx had held the jail contract since the 1990s, but faced recent criticism. In 2014, jail medical staff said a pharmacy technician, not a licensed pharmacist, was taking prescription orders in violation of Georgia law, leading to medication errors. Quick Rx denied the allegation, saying it adheres to state laws.

Musso initially wanted to hire another drug supplier, not Stephens’ company, said Karen Cotton, a retired major in charge of jail operations in 2016 with first-hand knowledge of the negotiations. “It was a political thing. Musso had to back off,” she said.

Stephens said his company was hired because it provides “exceptional pharmacy services” at good rates. CorrectHealth did not respond to queries about the hiring.

Musso had also forged a partnership with another politician, State Senator Lester Jackson, a Democrat popular with Chatham’s black community, who had served on the Democratic National Committee from 2009 to 2012.

Jackson owned a dentistry practice, Atlantic Dental Associates, that worked with Musso across the state since 2014. Today, Atlantic runs dental services at 18 jails with CorrectHealth.

Atlantic landed the Chatham County jail’s $197,500 annual dental contract from CorrectHealth a few months before Jackson appeared in pamphlets for Sheriff Wilcher during the white Republican’s campaign for a full four-year term that November. The image of a smiling Jackson shaking the sheriff’s hand cut across racial and partisan lines in the largely Democratic county, which is 41% African-American. It was a blow to Wilcher’s rival, McArthur Holmes, a black Democrat.

“See how politics comes into this thing?” Holmes said in an interview.

Jackson said he did not formally endorse Wilcher, but considers him a friend and did not object to the use of his picture. Holmes never sought his endorsement, he added.

Wilcher won by 10 percentage points, emerging as a steadfast CorrectHealth defender.

THE MONITORS

In July 2016, the county hired Rosenberg’s firm, Community Oriented Correctional Health Services. Founded in 2006, the Oakland nonprofit has served as a consultant to local governments in New York, Florida, California, New Jersey and Washington, D.C., at times called to testify before Congress.

In Savannah, it would assess the jail’s medical operations. If CorrectHealth performed poorly, it would suggest fines. Rosenberg’s account is taken from his team’s confidential reports, which Reuters obtained through an open records request.

Almost immediately, he and CorrectHealth began clashing.

At the end of CorrectHealth’s first month at the jail – August 2016 – the monitors urged the company to craft policies for dealing with mentally ill inmates, and told the county the provider was struggling to hire registered nurses for inmate intake screenings.

Long-running challenges over staffing “have not been rectified by CorrectHealth,” the monitors reported.

Soon, CorrectHealth grappled with its first inmate suicide.

At 5:19 a.m. on September 30, Guy Leonard hanged himself with a telephone cord barely three hours after he was booked. On an intake form, the nurse wrote that Leonard said he had no plans to hurt himself and did not appear intoxicated, though he had been arrested on a charge of public drunkenness.

After the suicide, the nurse changed the original intake form to say Leonard looked intoxicated at booking. The sheriff’s department scolded the medical team in a letter, saying altered forms “will give the appearance of impropriety by CorrectHealth.” The sheriff also fired two guards over their failure to check Leonard’s cell in the hour before he died, while a third officer resigned.

The monitors returned in November and reported that “not all inmates” were getting a full physical and mental health assessment in their first 14 days – a standard recommended by the correctional industry’s medical accreditation body. The reason, the monitors reported, was “staffing shortages.”

They also reported a breakdown in the delivery of prescriptions. Medications ordered for inmates were sometimes missing; at times, an inmate would be listed for the same prescription twice. CorrectHealth told the monitor the Quick Rx records system did not synchronize with its own electronic records, leading to prescription mistakes.

Nearly three months later, the monitors reported that a guard told them nursing staff had falsely claimed inmates were refusing medications, “when they actually just did not have the medication to administer to the patient because it had not been received from the pharmacy.”

The questions over Quick Rx were a potential embarrassment for the sheriff. Quick Rx owner Stephens, the ranking Savannah Republican in Georgia’s state house, had supported Wilcher with a $1,000 campaign donation. Stephens said the two have been friends “for many years” and that he contributes to many local officials.

In February 2017, Rosenberg’s firm recommended $3 million in fines for CorrectHealth over its staffing failures and the late delivery of medicines. By June 2017, the monitors had raised their fine recommendation to $5.2 million.

SUICIDES, QUESTIONS

On March 11, 2017, Demilo Glover, jailed a week earlier after an arrest on a drunk driving charge, told a nurse his medications had been changed and he hallucinated that a little boy had appeared in his room holding a can of green beans, a department report said. The CorrectHealth team moved him to a rear infirmary cell. Throughout the night, he screamed. Earlier, Glover, who described himself as bipolar, told medical staff he had not taken his antipsychotic and antidepressant prescriptions for one to two days before his arrest and made bad decisions when not medicated.

The next morning, March 12, two guards collected his breakfast tray and asked Glover if he was OK. After they left, Glover knotted his bed sheet around his neck and slung it from a pipe. Minutes later, the guards returned to the cell, finding his corpse.

Twice in the months before the suicide, monitors warned that the infirmary’s cells were dangerous for suicidal inmates. When the monitors told Wilcher the infirmary did not have enough nurses, he bristled. The sheriff, they wrote, “does not want to hear about anything having to do with CorrectHealth.”

FILE PHOTO: Jerome Hill climbs the stairs at the Chatham County Detention Center shortly before his suicide in Savannah, Georgia, U.S. in this September 30, 2016 handout photo. Chatham County Detention Center/Handout via REUTERS

On April 3 of that year, Jerome Hill, 36, was arrested for allegedly threatening his girlfriend with a handgun.

Barely 90 minutes after being jailed, Hill said he wanted to kill himself, a department internal affairs report said. At 6:20 p.m. on April 7, guard Sharon Pinckney opened Hill’s cell in the mental health wing to take him for a shower. Hill raced up the stairs to the wing’s second floor and, ignoring her pleas, jumped from the walkway’s railing, landing head first. He died 18 days later, while in a coma at a hospital.

Pinckney told investigators “she did not understand why she was alone dealing with inmates on suicide watch and who had other mental issues.”

The internal affairs report into Hill’s death makes no mention of his meeting CorrectHealth’s psychiatrist in his four days at the jail.

SHERIFF PUSHES BACK

As the deaths mounted, the sheriff began pushing back against the monitor’s scrutiny. In a June 2017 email, an aide to the sheriff told Rosenberg’s team they didn’t need to visit the jail so often.

On August 24, 2017, Wilcher emailed the county manager he “WOULD LIKE TO GET THE COACH [monitors] GONE THANKS SHERIFF.” He contended they hadn’t offered “one piece of advice” on how to correct problems.

Within two months, Rosenberg’s contract was terminated. At the same time, Wilcher was advocating that CorrectHealth’s contract be extended.

As the sides negotiated new contract terms, CorrectHealth balked at the millions in pending fines. At this impasse, county administrators began negotiating with Virginia healthcare provider MHM Centurion. CorrectHealth quoted a contract price of $8.6 million, saying the county had pressed it to hire more staff. But then Centurion quoted the county budget price of $7.1 million, and won the job.

At a county commission meeting October 20, 2017, Wilcher chastised the county. “I am happy with the provider I got,” he said.

Commissioners rebuffed him, voting 6-3 for Centurion. The company was supposed to take over one week later. But suddenly, the sheriff announced he could not finish the background checks for Centurion’s medical staff in time.

Faced with uncertainty, Centurion walked away. In turn, commissioners approved CorrectHealth staying on through June 2018 – ahead of the awarding of a new three-year contract. Centurion declined to comment.

The county waived CorrectHealth’s fines. Just one county commissioner, Chester Ellis, objected. “I think that was a conflict of interest because of the campaign donation,” he told Reuters, citing Musso’s donations to Wilcher.

INFLATED NUMBERS

In April 2018, CorrectHealth bid on a new healthcare tender. Among three bidders, its proposal received the poorest score from a county screening committee, but offered the lowest bid. One reviewer wrote: “1/10 on suicide prevention. Very little detail; Not thorough.”

Wilcher continued to back the company.

Without debate, County Commission Chairman Al Scott called an up or down vote on keeping CorrectHealth in June 2018. The vote was 6-1 in favor, with Ellis dissenting. Scott told Reuters the jail was the sheriff’s jurisdiction, so he followed Wilcher’s suggestion.

During the bidding, Reuters found, the company had inflated the costs of providing medical care when the county requested numbers to provide rival bidders.

Musso told the county he spent just over $1 million on drug costs. However, a Reuters review of CorrectHealth’s invoices from Quick Rx shows the actual spending on drugs in 2017 was $280,000 less. The inflated number allowed Musso to offer a lower bid than competitors. Musso did not answer questions about the conflicting numbers.

As CorrectHealth won the contract renewal, Wilcher hired his own monitor to offer guidance on securing a coveted accreditation from the National Commission on Correctional Health Care, an industry body that provides voluntary health standards for jails and state prisons and offers its seal of approval.

“We are not interested in, nor have or will we engage in, ANY activities or work that can be perceived to discredit you, the County, or its contractors,” monitor Ken Ray wrote the sheriff in his proposal. Ray did not respond to interview requests.

That June, NCCHC accreditation teams toured the jail and, two months later, the group sent notice it was granting a preliminary accreditation for the detention center’s healthcare services. The NCCHC also said it was awarding the jail the group’s first-ever certification for mental health services. At the time of its visit, the group said, the jail had not had a suicide in 12 months.

That was true, but the letter omitted the subsequent death of inmate Mosheh Underwood, 24, who hung himself in his cell August 4, 2018.

Upset after a call with his lawyer, Underwood had asked for paper to cover his cell window so he could have privacy to use the bathroom. A guard provided it – despite previous warnings from Rosenberg’s team about letting inmates cover their windows.

An hour later, Underwood, who hanged himself, was found dead.

Jaime Shikmus, the NCCHC’s vice president, said the sheriff’s office was not required to disclose the suicide because it occurred after the surveyors visited.

In the 48 hours before the jail’s certifications were formally unveiled, the sheriff and county worried in internal documents that its standing would be in peril if the organization got a complete picture of its problems.

In one email, jail administrator Todd Freesemann, then the sheriff’s policy and accreditation supervisor, advised Wilcher that the jail “does not have adequate mental health professionals to deal with the volume of mental health requirements.” In another, the county’s attorney warned the sheriff that the lack of registered nurses “jeopardizes your accreditations.”

On February 14, 2019, the news was officially announced. The Chatham County jail had won full accreditation for its mental health and healthcare services, becoming the first local jail to win this honor.

Four months later, a fifth inmate killed himself on CorrectHealth’s watch. Guards and medical staff rushed to resuscitate the inmate, but when they tried to revive his heart with a defibrillator, the first device was broken and the second’s battery was uncharged, a jail report said.

Today, CorrectHealth continues to hold its $22 million contract.

(Additional reporting by Peter Eisler and Grant Smith. Editing by Ronnie Greene)

Migrant deaths rise among Venezuelans, Central Americans: U.N.

FILE PHOTO: The U.S.-Mexico border is seen near Lukeville, Pima County, Arizona, U.S., September 11, 2018. REUTERS/Lucy Nicholson/File Photo

By Stephanie Nebehay

GENEVA (Reuters) – At least 380 Latin American migrants have died on their journeys this year, many of them Venezuelans drowning in the Caribbean or Central Americans perishing while trying to cross the U.S.-Mexico border, the U.N. migration agency said on Tuesday.

The toll, 50 percent more than the 241 recorded as of mid-June 2018, also coincides with tightened security along the U.S. southern border, which often leads migrants to turn to underground criminal smugglers and take riskier routes, it said.

President Donald Trump has made reducing illegal migration one of his signature policy pledges. His administration on Monday cut hundreds of millions of dollars in aid to El Salvador, Guatemala and Honduras, after Trump blasted the three Central American countries because thousands of their citizens had sought asylum at the U.S. border with Mexico.

“This month has been marked by several tragedies on the U.S.-Mexico border, where at least 23 people have died since May 30 May, that is more than one per day,” spokesman Joel Millman of the International Organization for Migration told a briefing.

IOM figures show that so far, 144 migrants are known to have died in Mexico, 143 in the Caribbean, 66 along Mexico’s southern border with Central America and 27 in South America.

A further 42 reported deaths were under investigation in Mexico, and of several dozen more refugees and migrants crossing the Darien jungle in Panama, he added.

“So we are seeing a level of fatality that we haven’t seen before. We caution that with the summer months just beginning, with the intense heat that brings, we can expect it to get worse,” Millman said.

Four million Venezuelans have fled their homeland, most of them since an economic and humanitarian crisis began in 2015, the U.N. refugee agency says. Most went overland to Colombia, Peru, Ecuador and Brazil.

But in images reminiscent of desperate Cubans fleeing their homeland in decades past, Venezuelans increasingly are taking to the sea in rickety boats.

The overall toll includes more than 80 Venezuelans who have died or disappeared in three shipwrecks in the Caribbean in the past two months, Millman said.

UNHCR spokesman Babar Baloch called for better search and rescue operations to save Venezuelans fleeing via the Caribbean.

“As Venezuelans continue to use dangerous sea routes to leave their country, the U.N. refugee agency is calling for more coordinated search and rescue efforts to prevent further loss of life,” Baloch said.”It is also absolutely vital that people are able to access safe territory in ways that do not require them to risk their lives,” he said.

(Reporting by Stephanie Nebehay; Editing by Mark Heinrich)

Isolation, evacuations in U.S. central Plains as floods kill three

Flooded Camp Ashland, Army National Guard facility, is seen in this aerial photo taken in Ashland, Nebraska, U.S., March 17, 2019. Picture taken March 17, 2019. Courtesy Herschel Talley/Nebraska National Guard/Handout via REUTERS

(Reuters) – Flooding that killed three people in the central plains of Nebraska and Iowa has cut roads to a nuclear power plant and inundated a large portion of a U.S. Air Force base, forcing it to work with a skeleton staff on Monday, while more of region’s residents possibly faced evacuation.

The floods, which have prompted each state’s governor to declare a state of emergency, are the result of last week’s “bomb cyclone” winter storm, a winter hurricane that blew in from the western Rocky Mountains. Three people died in the flooding and at least one person was missing after hundreds of weekend rescues.

Flooded Camp Ashland, Army National Guard facility, is seen in this aerial photo taken in Ashland, Nebraska, U.S., March 17, 2019. Picture taken March 17, 2019. Courtesy Herschel Talley/Nebraska National Guard/Handout via REUTERS

Flooded Camp Ashland, Army National Guard facility, is seen in this aerial photo taken in Ashland, Nebraska, U.S., March 17, 2019. Picture taken March 17, 2019. Courtesy Herschel Talley/Nebraska National Guard/Handout via REUTERS

The floodwaters forced the operators of the Cooper nuclear plant, near Brownville, Nebraska, to fly in staff and supplies by helicopter, and covered one-third of that state’s Offutt Air Force Base, near Bellevue, home to the U.S. Strategic Command. The nuclear plant continued to operate safely and was at full power, its operator said.

The National Weather Service reported that some of the region’s larger rivers were running at record highs above flood level, causing levy breaks. Some small towns and communities have been cut off by floods while others have seen fresh drinking water become scarce. Floodwaters destroyed many homes and businesses over the weekend.

The NWS reported that temperatures across the hardest-hit areas will reach above 50 degrees Fahrenheit (10 C) through midweek and exceed 60 Fahrenheit by Friday. That would speed the pace of snow melt across the region and contribute water to already swollen rivers, the NWS said, possibly forcing evacuations in communities along the Missouri River on the Nebraska and Iowa border, as well as along the Elkhorn and Platte rivers in Nebraska.

“There could be issues across portions of Nebraska and Kansas for the next seven days,” NWS meteorologist Jim Hayes said.

Nebraska Governor Pete Ricketts, who declared a statewide emergency last week, said on Monday that emergency officials have rescued about 300 people but that at least one person was missing.

At Offutt Air Force Base, 30 buildings had been flooded by up to 8 feet (2.4 m) of water and 30 more structures had been damaged, according to reports by the Omaha World-Herald, citing a base spokeswoman. Base officials did not immediately respond to a request for comment.

The flooding covered 3,000 feet of the base’s 11,700-foot runway, the World-Herald reported.

The weather was blamed for three deaths, including one person who died at home after failing to evacuate, and a man swept away while trying to tow a trapped car with his tractor.

In Iowa, one man died after he was submerged in floodwaters on Friday in Riverton, according to the Fremont County Sheriff’s Office.

Iowa Governor Kim Reynolds also issued an emergency proclamation at the outset of the flooding.

(Reporting by Gina Cherelus in New York and Rich McKay in Atlanta; Editing by Scott Malone)

Parts of ravaged Paradise open for first time since California wildfire

FILE PHOTO: Deer are seen on a property damaged by the Camp Fire in Paradise, California, U.S. November 21, 2018. REUTERS/Elijah Nouvelage/File Photo

By Saif Tawfeeq

PARADISE, Calif. (Reuters) – Thousands of Paradise residents who fled a monster blaze a month ago were allowed on Wednesday to return to some neighborhoods in the Northern California city nearly obliterated by one of the deadliest wildfires in U.S. history.

Tim Moniz, a rice farmer, and welder in his 50s, personally surveyed the remains of his Paradise property for the first time since the fire, confirming his suspicions that his house was gone. He and his wife only recently paid off the mortgage.

“It seems unfair that some houses make it and yours don’t,” Moniz said. “I just had to get back up and see it and try to salvage something.”

Paradise residents who return to their ravaged homes will face a daunting task to resume normal life, with some likely to encounter months or even years of work to obtain compensation for their losses and rebuild.

Authorities hurriedly evacuated some 50,000 people in Paradise and neighboring towns when the Camp Fire erupted on Nov. 8. The fire killed at least 85 people with nearly a dozen still unaccounted for. It also destroyed nearly 14,000 homes in the wooded, foothill communities.

Evacuation orders were previously lifted in areas outside Paradise, but Wednesday marked the first day officials opened parts of the city itself in the midst of the fire’s scorched wasteland of 153,000 acres (61,900 hectares).

REBUILDING A RESHAPED TOWN

Moniz said he is among those planning to rebuild, rather than move away.

But the fire’s devastation will reshape the town and – at least initially – lower its population, Paradise Mayor Jody Jones said by telephone.

“All my friends who are in their 80s, they’re just not going to go through this process of rebuilding,” Jones said, adding she believes three-quarters of Paradise residents will rebuild.

Some residents may be able to salvage jewelry or even stuff such as intact tool boxes from the rubble of their houses, said Jones, who lost her own home in the fire.

Some residents rumbled back into town in recreational vehicles, apparently planning to spend the night, Paradise Police Chief Eric Reinbold said by phone.

Authorities said they will let some residents stay overnight on their properties, but advise against it because electricity, gas and other services were not available.

Paradise’s skyline is dotted with 30 large cranes that crews are using to remove debris, said city spokesman Matt Gates.

Health and safety specialists are sweeping through Paradise to remove batteries, propane tanks, household chemicals and other environmental hazards in the aftermath of the fire, Gates said. Residents entering the re-opened areas of town were offered gear to protect themselves from hazardous materials, Reinbold said.

Full removal of debris could take nine months, Jones said.

(Reporting by Saif Tawfeeq; Additional reporting and writing by Alex Dobuzinskis in Los Angeles; editing by Bill Tarrant and Lisa Shumaker)