Pauly Denetclaw
ICT

WINDOW ROCK, Arizona — Navajo Nation President Buu Van Nygren was not coy about his intention to lift the COVID-19 mask mandates on the Navajo Nation once elected. This was one of his campaign promises that he made for his first 100 days. He’s kept that promise.

On Friday, Nygren signed an order that lifted the last of the COVID-19 restrictions that mandated masks be worn in schools, healthcare facilities and assisted-living homes.

“It’s an exciting time because it just shows that as president, I believe in our people at the local level, as well as really trying to empower them,” Nygren told ICT.

This decision was not made hastily. Since taking office the Nygren administration has been getting feedback from these facilities and institutions on what they wanted when it came to the Navajo Nation health mandates. According to Nygren, they wanted to have autonomy over their own policy and procedures.

“The schools, majority of them, wanted to lift it because it’s so hard to require the students to wear them in class, to go to school, all the write ups, and it was just really tough on the administrators,” Nygren said. “But as far as assisted-living facilities, that’s up to them. I know they run their own facilities. Health care facilities, that’s up to them.”

In January, Nygren lifted the general public indoor mask mandate with the exception of health care facilities, assisted living facilities and schools.

Beginning in spring of 2020, the Navajo Nation quickly sent workers home, shuttered offices and non-essential businesses, mandated masks, closed its borders to visitors and enacted curfews. This was in an attempt to limit the spread of the COVID-19 virus.

The nation became a hotspot for coronavirus cases and deaths over the course of the pandemic.

Approximately 170,000 people who live on the Navajo Nation, according to the U.S. Census. The Navajo Department of Health reported nearly 84,000 confirmed COVID-19 cases as of May 5, 2023. The nation also reported 2,117 deaths.

The pandemic worldwide has claimed nearly 7 million lives in the last three years, according to the World Health Organization.

On Friday, the World Health Organization determined that the COVID-19 pandemic was no longer a global health emergency, saying the virus has been on a downward trend for the last year. The United States is set to let its health emergency order end on May 11.

“I think I’d be so hesitant if the Navajo Nation was the first organization to reopen,” Nygren said. “I’d be very hesitant but a lot of entities around the Navajo Nation have been reopened, some of them, over a year now, some of them into the months. We’re just playing catch up at the moment.”

Cabinet member Rhonda Tuni, and head of the Navajo Department of Health, supports the removal of the final mask mandates on the nation.

“We are very excited to finally lift the mask mandate all across the Navajo Nation,” Tuni said. “Continue to practice the guidelines, hand sanitizing, and anything else that you’ve learned throughout these last three years.”

As the school year winds down, the mask mandate for next year has been a topic of discussion for the public schools on the nation.

“We’re very thankful to President Nygren and his staff to not necessarily lifting the mask mandate but just making it an option for our families,” said Shannon Goodsell, superintendent of Window Rock Unified School District. “This provides an opportunity for all of our students, all of our moms across the Navajo Nation to make the best decision for their families in order to keep their children safe while they’re in our schools. On behalf of the public schools across the Navajo Nation, we would like to say thank you.”

Fort McDowell Yavapai Nation, Hopi Tribe, Pueblo of Zuni and White Mountain Apache Tribe are the handful of tribes that still have a mask mandate, according to the Arizona Department of Education.

Earlier this year, Nygren received backlash about his decision to lift the general mask mandate.

The response on Nygren’s Facebook live announcing the lift is mixed, some people agree but many do not.

“I’m not here to please everybody but I’m here to make decisions as president,” Nygren said. “I think that’s very important. You got to make decisions and move on.”

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GILLETTE—Sandra Lane has been to the emergency room about eight times this year, she said. The 62-year-old has had multiple falls, struggled with balance and tremors and experienced severe swelling in her legs.

A paramedic recently arrived at her doorstep again, but this time it wasn’t for an emergency. Jason Frye was there for a home visit as part of a new community paramedicine program.

Frye showed up in an SUV, not an ambulance. He carried a large black medical bag into Lane’s mobile home, which is on the eastern edge of the city, across from open fields and train tracks that snake between the region’s massive open-pit coal mines. Lane sat in an armchair as Frye took her blood pressure, measured her pulse and hooked her up to a heart-monitoring machine.

“What matters to you in terms of health goals?” Frye asked.

Lane said she wants to become healthy enough to work, garden and ride her motorcycle again.

Frye, a 44-year-old Navy veteran and former oil field worker, promised to help Lane sign up for physical therapy and offered to find an anti-slip grab bar for her shower.

Community paramedicine allows paramedics to use their skills outside of emergency settings. The goal is to help patients access care, maintain or improve their health and reduce their dependence on costly ambulance rides and ER visits.

Such programs are expanding across the country, including in rural areas, as health care providers, insurers and state governments recognize the potential benefits to patients, ambulance services and hospitals.

Filling access needs

Gary Wingrove, a Florida-based leader in community paramedicine, said the concept took off in the early 2000s and now includes hundreds of sites. A 2017 survey of 129 programs found that 55% operated in “rural” or “super rural” areas.

Community medicine can be helpful in rural areas where people have less access to health care, said Wingrove, chair of the International Roundtable on Community Paramedicine. “If we can get a community paramedic to their house,” he said, “then we can keep them connected to primary health care and all of the other services that they need.”

Frye works at Campbell County Health, a health care system based in Gillette, a city of about 33,000 in northeastern Wyoming. Leaders of the community paramedicine program plan to expand it into two adjacent, largely rural counties dotted with ranches and coal mines on the rolling prairie that stretches more than 100 miles from the Black Hills to the Bighorn Mountains.

Gillette serves as a medical hub for the region but has shortages of primary care doctors, specialists and mental health services, according to a community needs assessment. People who live outside the city face additional barriers.

“A lot of them, especially older people, don’t want to come into town. And basically, those tiny communities don’t usually have health care,” Lane said. “I think it’s just kind of a pain for them to drive all the way into town, and unless they have a serious problem, I think they tend to just figure, ‘Well, it’ll work itself out.’”

Community paramedicine programs are customized to the needs and resources of each community.

“It’s not just a cookie-cutter-type operation. It’s like you can really mold it to wherever you need to mold it to,” Frye said.

Most community paramedicine programs rely on paramedics, but some also use emergency medicine technicians, nurses, social workers and other professionals, according to the 2017 survey. Programs can offer home visits, phone check-ins or transportation to nonemergency destinations, such as urgent care clinics and mental health centers.

Many programs support people with chronic illnesses, patients recovering from surgeries or hospital stays or frequent users of 911 and the ER. Other programs focus on public health, behavioral health, hospice care or post-overdose response.

Community paramedics can provide in-home vaccinations, wound care, ultrasounds and blood tests.

They can offer exercise and nutrition tips, teach patients how to monitor their symptoms and help with housing, economic and social needs that can affect people’s health. For example, paramedics might inspect homes for safety hazards, provide a list of food banks or connect lonely patients with a senior center.

Paramedics and patients said some rural residents struggle to access health care because of long distances, cost, lack of transportation or dangerous weather. Some hesitate to seek help out of pride or because they don’t want to be a burden to others. Some limit trips to town during ranching and farming crunch times, such as calving and harvesting seasons.

Delayed care can let health problems fester until they become an emergency.

Advocates say providing in-home care, resources and education can help patients reduce such crises and associated costs. Fewer emergencies mean fewer ambulance runs and hospital patients. That could help ambulance services and hospitals reduce costs and the time patients wait for help.

A 2022 scholarly review found that more studies are needed but that data so far suggests these programs reduce costs. It also found links to improved health outcomes and decreased use of ambulances and hospitals.

For example, a pilot program in Fort Worth, Texas, saw a 61% reduction in ambulance rides, according to an academic study of 64 patients. MedStar, the operator, made the effort permanent and says its 904 participants needed 48% fewer ambulance trips, saving an estimated $8.5 million over eight years.

But rural ambulance services, especially volunteer ones, can struggle to staff and fund community paramedicine programs.

Challenges

Kesa Copps, a co-worker of Frye’s, previously worked as an emergency medical technician in Powder River County, Montana, which has fewer than 2,000 residents. Some people there must drive more than an hour to reach the nearest hospital. The area’s volunteer ambulance service started a community paramedicine program in 2019.

Copps said the program reduced hospital readmissions and extended some elderly patients’ ability to live at home before being admitted to a nursing facility. She visited patients between ambulance runs and had to leave early when a 911 call came in. That’s different from the Campbell County Health model, in which community paramedicine is a full-time position, not split with emergency work.

Adam Johnson, director of the Powder River ambulance service, said the community paramedicine program shut down in 2021 after everyone with the necessary training left the area. Johnson said paramedics are signing up for training to restart the program.

States are increasingly recognizing and regulating community paramedicine, and some require licensed paramedics to obtain extra training to work in the field.

Some ambulance services and health care organizations have piloted community paramedicine programs with the help of state or federal grants. If they find the service saves money, they may decide to continue the program and fund it themselves.

Private insurance companies are increasingly covering community paramedicine, Wingrove said. Wyoming and several other states allow operators to bill Medicaid for the services.

Advocates are now pushing Medicare to expand its limited coverage of community paramedicine, Wingrove said. That would benefit Medicare patients and could spur more private insurers to offer coverage.

The Campbell County Health program’s home visits cost up to $240 per hour and are billed to Medicaid or Medicare, Frye said. That compares with more than $1,300 for an ambulance ride and thousands of dollars for a visit to a hospital ER.

Community paramedicine may soon expand in neighboring South Dakota, another largely rural state.

South Dakota ambulance services have experimented with community paramedicine and lawmakers recently voted to authorize and regulate it.

Eric Emery, the state representative who introduced the bill, plans to start a program on the sprawling, rural Rosebud Indian Reservation, where he works as a paramedic. He said the operation will focus on diabetes and mental health care.

Emery, a Democrat, said some people struggle to pick up their medication and attend appointments because they lack vehicles or gas money and there’s no public transportation to the hospital. He said some parents and grandparents raising children also struggle to find time to drive to appointments.

“They’re putting the needs of the younger generation or their grandkids before their own,” Emery said.

Back in Gillette, Frye also checked in on Linda Gwitt, a 78-year-old facing diabetes, depression and a lack of social support after her husband was hospitalized with dementia. Gwitt said her husband was her walking buddy and helped care for her.

“I had him to wait on me, and now I have nobody,” Gwitt said.

Frye said he would see if he could help start a senior walking group that Gwitt could join. He told her socializing can improve health.

“You’re not alone,” Frye told Gwitt.

This story was originally published on KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling and journalism. Learn more about KFF.

The post Community paramedics fill gaps in preventative care needs appeared first on WyoFile.

This story is the first in Fresnoland’s ongoing series taking a deep dive into how local governments have spent pandemic relief dollars from the federal American Rescue Plan program.

In 2020, the COVID-19 pandemic handed the Clovis Rodeo Association its first annual loss in a decade when it had to cancel its flagship event. After bringing the Clovis Rodeo back in-person with limited crowd capacity the following year, the association ended up with an even bigger annual loss.

Despite two years of deficits, the Clovis Horse Show and Festival Association, the nonprofit organization behind the rodeo, wasn’t at the brink of collapse — mostly because it had more than $1 million in cash heading into the pandemic.

But that didn’t stop the rodeo from applying to be a subrecipient of federal pandemic relief dollars through Fresno County. In June 2022, the Fresno County Board of Supervisors approved reimbursing the rodeo for 2022 expenses at the sum of $200,000, using federal relief funds.

“It’s going back to the next rodeo — the livestock, the security, the supplies,” said Ron Dunbar, the rodeo’s president. “Without that fund, we wouldn’t be able to do what we like doing, what we’re used to.”

While the county is allowed to use federal relief funds to address the negative economic impact of the pandemic on local businesses, it brings into question Fresno County’s process in awarding organizations funds through the American Rescue Plan Act (ARPA), a federal program which gave $350 billion to local governments across the country to rebuild their economies.

Fresno County officials did not assess whether organizations that applied for funding actually needed federal relief dollars in order to stay afloat, county staff told Fresnoland. County officials also did not develop a metric to evaluate organizations’ equity aims in order to evaluate their impact on underserved communities or to compare applicants with each other.

Over the last two years, the county got $194 million in ARPA dollars from the federal government. Eligible uses of the federal funds include revenue replacement for government agencies, premium pay for essential workers, upgrading water, sewer, and broadband infrastructure, and financial assistance to businesses dealing with the negative economic impacts of COVID-19. Local governments that receive funding can either use the funds themselves or disburse the funds to subrecipients — both of which Fresno County has done since last year.

The unprecedented infusion of cash for local governments had great potential to bridge equity gaps, considering it didn’t have the typical constraints of annual government budgets. Last year, President Joe Biden even put out a 301-page report on how the ARPA program was his first opportunity to advance equity through major legislation.

Fresno County received 47 applications from organizations seeking funding from its ARPA subrecipient program. In May 2022, four county staff members evaluated whether applications met eligibility requirements from the federal government, said county spokesperson Sonja Dosti. She added that the five county supervisors’ chief staffers also weighed in on the process, evaluating whether applications aligned with county guiding principles on how to spend federal relief dollars. 

They forwarded a recommended list of organizations that should get funding to the county’s Ad-Hoc Committee on ARPA, which was composed of two people: supervisors Nathan Magsig and Steve Brandau. 

The two county officials approved and sent a priority list of organizations to the Board of Supervisors, which they subsequently approved in June 2022. The Clovis Rodeo was one of the 22 organizations accepted into the program. It was also one of three event-centered subrecipients — including the Big Fresno Fair and the Turkey Testicle Festival. 

Among the 25 programs that didn’t get funding, one sought to increase education on voting, digital literacy and broadband infrastructure for underserved communities. Another program sought to boost enrollment in public programs — like CalWORKs, Medi-Cal and CalFresh — for residents in geographically isolated parts of Fresno County.

Pandemic brought down rodeo's cash totals, but not to the brink of collapse, tax documents show

After two consecutive years in deficit — losing about $265,000 over 2020 and 2021 — the Clovis Horse Show and Festival Association still had more than $930,000 in cash. That’s largely because over the five years prior to the pandemic, the rodeo earned an average of $1.56 million in annual revenue and took home an average of about $277,165 in annual profits, which it used every year to either plump its cash accounts or acquire more land or property, according to the rodeo’s tax documents obtained by Fresnoland.

Alfreda Sebasto, a spokesperson for the rodeo, emailed a statement to Fresnoland, explaining that the rodeo’s annual cash totals are not cash reserves, since they aren’t entirely retained throughout the year and are used for operational expenses required to put on the rodeo every year. Sebasto did not respond to a request for the rodeo's 2022 gross revenue and total expenses.

Fresno County’s selection process for ARPA subrecipient funding did not include comparing organizations to each other in terms of their current resources and whether that tied into their overall need for federal relief money, said George Uc, an ARPA analyst at Fresno County. Instead, the county’s process was mainly focused on assessing applications for whether they met guiding principles and priorities set by Fresno County officials, which include addressing negative outcomes exacerbated by the pandemic and its immediate impacts.

"It's not that one application is better than the other,” Uc told Fresnoland. “It was more of identifying those that wouldn't duplicate funding sources and achieve the board's principles."

Every organization that applied for funding had to explain how it would “promote strong, equitable growth, and racial equity among impacted communities in Fresno County.” In response to that equity question, the Clovis Rodeo stated it does not discriminate against anyone, strives to be a family-friendly event and has affordable tickets between $20 and $35, according to its application for subrecipient funding, which Fresnoland obtained through a California Public Records Act Request.

In its application, the rodeo did not highlight a specific community or underserved group that its programming would specifically benefit, but did note how doing “outreach to underserved audiences, local schools and all interested is a part of the Association's core mission.”

Uc said that equity was assessed across all 47 applications for ARPA funding, however, the county did not develop a metric to compare the rigor of each organization’s equity aims with each other. He added that equity was assessed by understanding how each organization would have a lasting, transformational impact if given federal relief dollars. 

County staff understood the rodeo’s equity aims as generating $15 million in revenue for the region, which helps businesses that depend on the event to make profit. He also said the rodeo is a boon for hotels, since it brings people from all over — including Merced, Bakersfield and Los Angeles — to Clovis. 

"I think looking at (the Clovis Rodeo) from travel, hospitality sectors — what it does — that's the equitable part of it,” Uc said.

Are county officials addressing inequities with ARPA dollars?

Fresno County’s approach to equity with ARPA dollars has been strongly criticized in the past. The California Pan-Ethnic Health Network, a statewide health advocacy organization, researched and analyzed how 12 of California’s largest counties spent ARPA funds in 2021. It gave Fresno County the lowest score, an “F,” since the county hadn’t even acknowledged racial inequities or underserved communities in its 2021 ARPA recovery plan report.

“The Board of Supervisors came up with these broad principles of how they want to use ARPA funding on their website and there's no mention of equity at all in the broad principles,” said Weiyu Zhang, an associate policy director at the California Pan-Ethnic Health Network. 

Since then, Fresno County seems to have improved its approach somewhat, Zhang told Fresnoland, because its 2022 ARPA recovery report is much more detailed in terms of highlighting racial groups in Fresno County and social vulnerability statistics. However, she added that nothing actually keeps counties in check for using ARPA dollars to address equity issues.

"There's really just the power of communities collectively calling out their elected officials to apply public pressure," Zhang said. 

That’s not to say none of Fresno County’s ARPA dollars have been used to address equity gaps. The county earmarked about $5 million for improvements to water infrastructure in Mendota and Malaga. 

Furthermore, in 2022, county officials earmarked $150,000 to improve a park in El Porvenir and earmarked another $1.6 million to improve the community center in Lanare — both of which impact two rural unincorporated communities in the county.

“It's thanks to persistence and the community being involved in this decision-making process that I believe this was able to happen,” said Mariana Alvarenga, a policy advocate with the Leadership Counsel for Justice and Accountability. “So really just applauding the community and thanking the county for really listening — but also encouraging them to be more critical in thinking about what more can be done in the county.”

Alvarenga said that includes addressing broadband issues and further unmet infrastructure needs impacting unincorporated communities. But by now, $170.9 million in ARPA dollars have already been allocated by the county's board of supervisors, leaving about $23 million up for grabs.

"It's frustrating to think about ARPA funding things like the Clovis Rodeo,” Alvarenga said. “We believe that there are more pressing needs that impact people's day to day lives that should be addressed with these funds.”

The post Why did Fresno County give the Clovis Rodeo pandemic relief funds? appeared first on Fresnoland.

Wyoming Attorney General Bridget Hill and Gov. Mark Gordon oppose the secretary of state’s request to join their defense of the state’s abortion ban in an ongoing lawsuit.

Gordon and Hill, both defendants in the case challenging the ban, claim in a brief filed Tuesday that Chuck Gray doesn’t have legal standing, and that joining the case “in his official capacity” as secretary of state is contrary to Wyoming statutes.

“Public officers such as the Secretary of State ‘have and can exercise only such powers as are conferred to them by law,’” the filing states, citing the case McDougall v. Board of Land Commissioners of Wyoming.

“In Wyoming, the powers and duties of the Secretary of State are prescribed by the Wyoming Legislature,” the filing continues. “In his official capacity, Secretary of State Gray cannot intervene in this case unless a Wyoming statute authorizes him to do so.”

While Gray has argued he has standing given his role as successor to the governor and public records custodian, the defendants state neither give him authority to intervene or even participate in the trial.

Plaintiffs fighting for abortion access noted that potential intervenors could request to file amicus briefs in the case if denied the right to intervene. That option would allow them to share their perspective and evidence.

“In his official capacity, Secretary of State Gray cannot intervene in this case unless a Wyoming statute authorizes him to do so.”

AG/Governor filing in abortion ban case

Gordon and Hill, however, argue that Gray should not be allowed participation of any kind.

Ninth District Court Judge Melissa Owens has scheduled a hearing for May 24 at 1 p.m. to consider arguments from all sides for and against admitting the potential intervenors. Other defendants in the case have until May 1 to file a response to the intervenors’ request, and the intervenors have until May 19 to reply.

The governor and attorney general don’t oppose Right to Life of Wyoming or Reps. Rachel Rodriguez-Williams (R-Cody) or Chip Neiman’s (R-Hulett) requests to intervene in the case. The defendants do, however, “disagree with the intervenors’ apparent belief that this Court should hold an evidentiary hearing or a formal trial in this case and do oppose this Court granting them intervention based on the premise that such a hearing or trial is necessary.”

The case only involves “questions of law,” the filing states, which precludes the need for such a hearing or trial. That suggests the judge should only consider whether the new abortion bans are constitutional on their face, excluding information or evidence that goes beyond what’s needed to make that narrow determination.

Instead, defendants argue, the judge should issue a “summary judgment,” which would limit expenses for all parties.

The potential intervenors — excluding Gray — tried to intervene in the case over the state’s previous ban last year, but were denied. They appealed that decision to the Wyoming Supreme Court, but asked it to be dismissed in light of the 2023 ban that replaced the one from 2022.

Observers expect the case to ultimately be decided by the Wyoming Supreme Court, regardless of the outcome in district court, where it currently sits.

The post Gov., AG oppose secretary of state’s request to join abortion ban defense appeared first on WyoFile.

When gases from large livestock facilities overwhelm communities, the health impacts can be severe.

Children at schools near concentrated animal feeding operations, or CAFOs, are more likely to experience asthma. Exposure to ammonia and hydrogen sulfide — both emitted in large quantities by CAFOs — can lead to chronic respiratory issues, and in some cases, cause damage to the nervous system.

In states like North Carolina and Ohio, families that are Black, Hispanic or low-income are more likely to suffer the consequences.

Yet 18 years after starting to develop methods to measure and control air pollution from livestock operations, the Environmental Protection Agency still has not complied with its own mandate to protect Americans from the harmful health effects of air pollution from big farms.

And thanks to an agreement between the EPA and livestock industries, thousands of CAFO owners are shielded from some EPA penalties while the process of developing tools to measure emissions drags on.

“It’s a huge problem,” said Carrie Apfel, senior attorney in the Sustainable Food and Farming Program at Earthjustice, a nonprofit environmental justice legal organization. “The huge problem is that the agricultural lobby is hugely powerful and hugely influential, and I really think that has a lot to do with it.”

An EPA Office of Inspector General report that investigated the delay in 2017, however, indicates a lack of technical expertise and resources within the EPA is largely responsible for hampering the agency’s progress toward regulating air emissions from livestock operations.

Regardless, in CAFOs thousands of livestock animals live in covered barns, where they eat, drink and poop in mass quantities.

That manure, usually stored in tanks or lagoons, undergoes chemical transformations, releasing harmful chemicals into the air.

Under its authority provided by the Clean Air Act, the EPA sets limits for how much of these chemicals are emitted, but the agency still does not have a method for calculating how much pollutant a livestock facility produces.

For many other industries that cause air pollution, EPA scientists have created formulas to estimate how much pollutant a facility emits.

In 2005, the agency said it would finalize these models, called emissions estimating methodologies, or EEMs, for livestock operations by 2009. It still has not done so.

EEMs to be finalized this year following public comment, industry review

The EPA published its first draft EEMs for CAFOs in 2012, but after receiving criticism from the agency’s Science Advisory Board, it did not publish revised drafts until 2020.

Since 2020, the agency has periodically published revised drafts of the livestock facility EEMs for various chemicals, including ammonia, hydrogen sulfide, particulate matter, and volatile organic compounds. However, the recent drafts do not address all of the Science Advisory Board’s recommendations.

The drafts will not be reviewed again by the advisory board, as the agency has moved beyond the peer-review portion of the EEM development process.

“Now that the draft emission models for all animal sectors are complete, EPA will review and revise all models before releasing the entire set of models for stakeholder review” later this year, EPA spokesperson Shayla Powell said in a statement to Investigate Midwest.

The agency will finalize the EEMs after a public comment period, Powell said. The agency did not specify when the public comment period would start.

Some environmental groups say the current EEM drafts for livestock operations are insufficient, and that the data forming the basis of the formulas are flawed, in large part because of livestock industries’ involvement in the research behind the EEMs.

“The study was designed to fail,” Tarah Heinzen, the legal director for Food and Water Watch, said. “It was largely designed by industry. It didn’t result in usable data, or complete data, even for the very small number of facilities that were studied.”

Environmental, industry groups await final models 

Food and Water Watch, which has worked on the issue of livestock operation EEMs since 2012, petitioned the EPA in 2021 to end the contract between EPA and CAFO owners because it provides legal protections to some CAFOs. The EPA has not yet responded to the petition, but did meet with the coalition once in August 2022.

Despite seeing insufficiencies in the current drafts, Earthjustice believes the EPA should finalize and enforce the drafts before working on improved versions.

Food and Water Watch said the EPA should “put an end to the federal amnesty and abandon the EEMs process entirely, because the flawed NAEMS study is incapable of producing viable emissions models. However, if EPA insists on finalizing EEMs, than at the very least it should not continue to provide amnesty to polluting CAFOs in the meantime.”

“The reality is that facts and science change over time, and emissions assumptions will also change over time,” the coalition wrote in its petition. “There is no end to that process. However, EPA can, and routinely does, estimate emissions from many sources of air pollution, including (animal feeding operations), using the best science available. The agency must do the same here.”

Andrew Walmsley, senior director of government affairs for the American Farm Bureau Federation, the largest lobbying group representing the agriculture industry, said the group is opposed to “air permits that are not science-based for farms.”

“Our policy also opposes mandatory standards because with (standards) would undoubtedly come enormous compliance costs, including permitting fees, and a mountain of new paperwork,” Walmsley said.

Two laws requiring facilities to report air emissions have been amended in recent years to exempt CAFOs from the rules, but the Clean Air Act still applies to livestock operations.

“I think that there’s a very strong but false narrative on the other side about the struggling farmer and how hard it is to comply with these regulations,”

Carrie Apfel

Under the Emergency Planning and Community Right-to-Know Act of 1986 (EPCRA), livestock operations were among the facilities required to report emissions of ammonia and hydrogen sulfide that exceeded legal limits — until 2019, when the Trump-led EPA exempted CAFOs from the law. Environmental advocacy groups including Food and Water Watch sued the EPA to reinstate the reporting requirement for CAFOs, but the exemption remains in place.

A 2018 law passed by Congress — the FARM Act — also exempted livestock operations from reporting air emissions under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA).

The EEM development process is one piece of a pattern of regulatory exemptions for large agriculture operations, said Carrie Apfel, senior attorney in the Sustainable Food and Farming Program at Earthjustice.

“I think that there’s a very strong but false narrative on the other side about the struggling farmer and how hard it is to comply with these regulations,” Apfel said. “When you do a deeper dive into the regulations themselves, the small family farmers aren’t emitting enough to trigger any sort of regulatory requirements. A lot of these regulations are really targeted at the big industrial agricultural facilities that are sophisticated and big enough to comply with these regulations.”

The Biden administration has said publicly it plans to revisit the EPCRA exemption for CAFOs, but has not yet moved forward with the rule.

If the Biden-led EPA does reinstate the reporting requirement, CAFOs that release pollutants in excess of EPCRA emissions thresholds of 100 pounds per day of ammonia or hydrogen sulfide would have to report the pollution to authorities. That information would be publicly available.

Even if the agriculture exception to EPCRA stands, livestock operations would still need to use the EEMs to determine their compliance with the Clean Air Act and obtain Clean Air Act permits, if they exceeded emissions thresholds, said Emily Miller, an attorney with Food and Water Watch.

Ray Atkinson, director of external communications for Smithfield Foods, one of the biggest pork companies in the U.S., said the company does not expect the EEMs to have a significant impact on Smithfield’s operations.

Both the National Milk Producers’ Federation and National Pork Producers Council told Investigate Midwest they would comment on the EEMs once the final versions are released by the EPA.

The National Pork Producers Council, which participated in the study of CAFO air emissions, noted that “EPA has an obligation to finalize these long overdue tools for producers to use.”

Associations representing the egg and poultry industries did not respond to requests for comment. Investigate Midwest also reached out to other large U.S. meat companies, including Tyson and JBS, but did not receive responses.

CAFOs remain protected today from some EPA penalties

CAFOs were few and far between in the U.S. until the late 1990s, when the livestock system began to transform, becoming more concentrated. In states like North Carolina, and later Iowa and Minnesota, the quantity of large CAFOs rapidly increased over the last two decades.

Today, the vast majority of American meat comes from animals raised in CAFOs.

In the early 2000s, few studies measured the actual emissions from livestock barns. In response to the increasing concentration of CAFOs and the operations’ impact on human health, the National Academy of Sciences called on the EPA in 2002 to further study air emissions from CAFOs.

Without sufficient existing data to create emissions estimates, the EPA turned to the livestock industry for a solution.

Over the course of two years, the agency negotiated with the dairy, egg and pork industries to determine how to study CAFO emissions.

In 2005, the parties landed on a deal, called the Air Compliance Agreement.

Participating producers from each of the industries volunteered as potential study subjects and paid a one-time civil penalty, ranging from $200 to $1,000 per CAFO, depending on the facility’s size. (In recent years, companies in industries other than livestock found to be in violation of the Clean Air Act have paid multi-million dollar penalties.)

More than 2,500 owners and operators representing 13,900 animal feeding operations — more than 90% of the country’s CAFOs — paid penalties to the EPA.

Those penalties would pay for a study to collect emissions data from the CAFOs. The EPA would then use the data to create its EEMs, which would inform its enforcement of the Clean Air Act in the future.

In exchange for the industries’ participation and funding, the EPA promised not to sue the participating producers for certain past and ongoing violations of air emissions laws while the study and EEM development process were ongoing.

The contract would stay in effect until the EPA notified the CAFO owners that the EEMs had been finalized, or until the agency determined it would be unable to create the EEMs. It is still in effect today.

For 18 years, this agreement has shielded nearly 14,000 CAFOs from EPA penalties – yet only 25 facilities actually participated in the data collection.

At the time the agreement was established, meat companies were fearful of lawsuits and EPA penalties over the pollution they produced, said Garth Boyd, who represented Smithfield, one of the country’s largest pork companies, in the negotiations over the study and agreement.

All Smithfield operations at the time signed the contract, Atkinson told Investigate Midwest, and two of its facilities participated in data collection for the study, called the National Air Emissions Monitoring Study, or NAEMS.

Boyd remembers the consent agreement being “controversial” among those on the private industry side of the negotiations, because companies were hesitant to pay the upfront penalty and admit to emitting pollutants.

But others, including Boyd, believed the EPA was negotiating in good faith and that the agreement could protect companies from bigger fines in the future.

“At the time, it seemed to make sense to me to sign the (consent) agreement, because things were tense and it looked like it would possibly prevent penalties,” Boyd said.

John Thorne, a lobbyist representing livestock organizations in the negotiations, said the industries had a mixed response to the consent agreement.

“They were distrustful of anything the EPA had its stamp on,” Thorne said.

Thorne added that livestock industry leaders were fearful that the study and consequent EEMs would eventually force the companies to spend massive amounts of money to curtail emissions.

Critics question sufficiency of data behind EEMs

After working out a deal to fund the research, the industry and EPA stakeholders next needed to decide who would run the study.

The committee selected Albert Heber, Ph.D., agricultural air quality expert and professor at Purdue University, to oversee the study design and data collection for the NAEMS.

NAEMS, which collected data from 2007 through 2010, is still the largest study of its kind, Heber said.

Heber had consulted for both the EPA and for livestock producers, so he represented a middle ground between the EPA and the industries the agency regulates, he said. He had also served as an expert witness for both the EPA and livestock operators in nuisance cases.

“Environmental groups say the study is industry tainted,” Heber said. “So here’s my answer: It wasn’t tainted in any way. Purdue was totally independent in the selection of specific sites. I personally selected the sites. I personally selected the research team and oversaw the conduct of the study.”

Heber said he didn’t take directions from industry leaders, but he did discuss site selection with industry groups to understand which types of facilities were most common in each industry.

“The only part of the (study) design that they were involved with is, what type of barns and farms should be included?” Heber said. “That was a collaborative effort, but they have the information on what kind of farms they have.”

Heber’s team monitored emissions at 27 sites on 25 CAFOs in 10 states. (At two of the CAFOs, teams monitored multiple emissions sites.) The team monitored each site continuously for two years.

Heber said that he chose to monitor a smaller number of sites for a longer period of time to better understand how factors like weather and animal life cycles impacted emissions.

Critics, including some environmental groups and scientists, say that the data is insufficient to create rules for the entire country, and invalid because of the industry’s role in crafting the study.

“The sample size was not large enough, to be honest,” said Viney Aneja, Ph.D., an agricultural air quality expert and professor at North Carolina State University, who served on an EPA Science Advisory Board panel that reviewed the first drafts.

When the EPA published the NAEMS protocol for public review in 2005, many stakeholders submitted comments, concerned that the number of monitoring sites was too few to account for the diversity of livestock operations across the country.

The final dataset that forms the basis of the draft EEMs includes data from two Tyson Foods CAFOs submitted by company-funded researchers and validated by the EPA, as well as other data provided by respondents to a “Call for Information” by the EPA.

Prior to the start of the National Air Emissions Monitoring Study, Tyson had already dedicated $1 million to Iowa State University researchers for a study of ammonia emissions. As part of the Air Compliance Agreement, the team studying the two Tyson facilities expanded the monitoring to encompass all of the chemicals included in the NAEMS and to meet the EPA’s quality assurance criteria.

RELATED STORY: 7 key moments in EPA’s 18-year-long delay in measuring livestock air emissions

Atkinson, the spokesperson for Smithfield, said the EEMs would be “useful” but noted that the pork industry has adapted since the NAEMS.

“Much has changed over this time period that has likely impacted the base data used to develop the EEMs,” Atkinson said. “For instance, feed conversion and overall efficiency have improved industrywide, along with a reduction in the amount of crude protein fed. Both have had the effect of reducing emissions.”

The EPA stands by the validity of the data.

“The EPA is comfortable the data are sufficient to develop an emission estimation method for the animal operations monitored by NAEMS,” the agency said in its response to questions from Investigate Midwest. “EPA is open to discussing options for future monitoring and data collection projects to both expand the amount and type of data available for these operations and how to expand to other animal operation types (e.g., cage-free egg layers) as the industry continues to change.”

Key reasons for delay: conflict with Science Advisory Board, lack of resources 

The EPA published the first draft EEMs in 2012.

But the revision process stalled after a panel of the EPA’s Science Advisory Board reviewed the drafts and took issue with aspects of the formulas.

The panel sent a letter to the EPA in 2013 outlining issues with the drafts, particularly with the data that formed the basis of the formulas.

“The EPA has developed statistical models based on combined data sets and predictor variables which have limited the ability of the models to predict emissions beyond the small number of farms in the dataset,” the panel wrote.

“While basing the EEMs on data from a small number of farms does not necessarily limit the applicability of the EEMs to national populations,” the 2012 drafts should not be applied to all CAFOs, the panel said.

The panel’s final report includes several recommendations for the drafts, many of which involve clearly stating the limitations of the NAEMS data for users.

The Science Advisory Board panel strongly recommended that the EPA use a “process-based” model for the EEMs. A process-based model would require more data than the agency had access to at the time, and would be more time-consuming to produce, but would more accurately represent the wide range of factors that contribute to emissions at CAFOs around the country, the panel wrote.

Upon receiving the Science Advisory Board’s recommendations, the EEM development ground to a halt. The EPA stopped dedicating resources to the effort and key staff retired, according to the 2017 EPA Office of Inspector General report investigating the delays.

“EPA has made strategic hires to bring in talent with agricultural air expertise to work specifically on this project,” a spokesperson for the agency said in February.

“The fact of the matter is, if the study had included a diverse background of scientists to help advise in the design of the study, the nation would have benefited enormously. That did not happen.”

Dr. Viney aneja

The National Resource Council and the GAO both also recommended the agency use a process-based, rather than a statistical approach. Food and Water Watch attorneys argued that a process-based approach would be easier to implement for farmers.

The EPA’s current draft EEMs do not use a process-based approach.

“The amount of input data that you need to run these models is mind boggling,” said Heinzen, the legal director for Food and Water Watch. “To think that every animal feeding operation owner and operator across the country who needs to comply with the agreement, following the publication of these, is going to be able to do that successfully is ridiculous.”

The EPA told Investigate Midwest it will create a tool to assist CAFO owners and operators with inputting the required data, such as weather conditions.

Aneja, who participated in the Science Advisory Board review of the initial drafts, took issue with the funding of the study and the lack of involvement of scientists and university departments from disciplines outside of agriculture.

“The fact of the matter is, if the study had included a diverse background of scientists to help advise in the design of the study, the nation would have benefited enormously,” Aneja said. “That did not happen.”

The post 18 years and counting: EPA still has no method for measuring CAFO air pollution appeared first on Investigate Midwest.

By Ivey Schofield

Troaria Sampson wanted to be a mom.

But Sampson, who weighed 360 pounds and had diabetes, said her doctors in Robeson County discouraged her from pregnancy, warning that her baby could die.

In 2015, after trying for five years with her husband, Sampson got pregnant at age 27 – a milestone that should have excited her but instead filled her with guilt and dread.

“There are people like me who don’t have insurance and are being judged by their outer appearance,” said Sampson, who is Black and worked at the time as a cashier at Food Lion. “But it didn’t lessen my want to be a mother.”

Sampson visited doctors in the early weeks of her pregnancy, but many women in Robeson County do not receive such prenatal care that health officials say is crucial for the well-being of mothers and their babies.

Robeson is not considered a maternal care desert, according to the March of Dimes, which tracks access across the country. UNC Health Southeastern in Lumberton says it delivers about 1,200 babies each year.

But Robeson ranks last among North Carolina’s 100 counties for the percentage of pregnant women who receive early prenatal care, with 53% visiting a doctor during their first trimester, according to Healthy Communities NC.

Other counties in North Carolina’s Border Belt aren’t far behind, with about 56% in Columbus County, 58% in Scotland County and 61% in Bladen County, data shows.

The state’s goal is for 80% of pregnant women to receive health care during their first trimester by 2030.

Several organizations across southeastern North Carolina, including health departments, hospitals and pregnancy centers, are trying to increase awareness and access to prenatal care. Health officials say Medicaid expansion, which the state legislature adopted in March, will help ease the financial burden for low-income women who are pregnant.

A lack of prenatal care increases the chances for labor complications, birth defects, and hypertension and postpartum hemorrhages, said Dr. Donald McKinley, an obstetrician and gynecologist at UNC Health Southeastern.

“Prenatal care is absolutely one of the most important aspects of having a healthy pregnancy,” he said. “When pregnant, the patients need to be seen as soon as possible to change medication or start medication to survive a very important developmental stage.”

Pregnant women might be hesitant to seek care for a variety of reasons, including illegal drug use, lack of health insurance, lack of transportation to appointments and previous negative experiences with doctors, experts say.

Sampson said her interactions with medical professionals added to her skepticism during her subsequent pregnancies. She now has three children.

About 12% of married Black women report facing at least one barrier to receiving prenatal care, compared to 9.8% of white women, according to a 1997 study. Black women have the highest maternal mortality rate in the United States, with 69.9 per 100,000 dying due to their pregnancy, compared to 26.6 per 100,000 white women, according to 2021 data from the Centers for Disease Control and Prevention. Data was not available for Native American women.

Sampson said she ultimately got the support she needed from Healthy Start, a program at the University of North Carolina at Pembroke that has been funded by the federal government since 1998 to reduce the infant mortality in Robeson County.

“Every appointment,” Sampson said, “they were there.”

Megan Knight, who lives in the Bladen County town of Dublin, said early prenatal care changed her experience. She had complications during her first two pregnancies. When she got pregnant for a third time, she saw a doctor who told her she had a defect with MTHFR, a gene that tells the body to metabolize folic acid.

Knight said she started taking blood thinners and didn’t experience any complications during her third and fourth pregnancies.

“Complications occur because we’re afraid, we don’t seek help or we say, ‘I can’t get a ride, I don’t want to tell my mom or my boyfriend I’m pregnant,’” Knight said. “And that creates risk. But those risks can be easily eliminated.”

Local resources

Knight, who recently opened a pro-life pregnancy center called Mercy House in Elizabethtown, wants to help pregnant women in Bladen County access prenatal care.

Bladen County is considered a maternal care desert, where there is no hospital or birth center that offers obstetric care and there are no obstetric providers, according to a recent report by March of Dimes.

Mercy House offers free medical-grade pregnancy tests, online pregnancy and parenting classes, diapers, clothes and emotional support.

“I know that when women are in crisis, their immediate response is I need to get rid of this,” Knight said. “And we want them to know they’re not without hope, they can do this and there are resources.”

Janet McPherson, who oversees Living Hope, a Christian-based pregnancy center in Columbus County, said many pregnant women don’t know about local resources.

“There’s not any one place you can go and say, ‘If you’re pregnant, this is what’s available,’” she said. “This is a real problem. There is no coordination among ministries and groups.”

Pregnant women should contact their county health department to find if they qualify for Medicaid and WIC, a nutrition program for mothers and young children, said Carlotta Rivers, maternal health coordinator at the Scotland County Health Department. Parenting and breastfeeding classes are also available.

Women with high-risk pregnancies due to substance misuse, domestic violence, homelessness or other factors can qualify for pregnancy care case management that includes monthly check-ins from social workers, said Barbie Britt, nurse supervisor at the Robeson County Health Department.

“We try to do as much as we can here,” Britt said.

Coastal Horizons, a Wilmington-based nonprofit with a pregnancy and postpartum office in Whiteville, offers specialized help for pregnant women struggling with addiction, program coordinator Gayle Beese said.

The office communicates with local medical providers to make sure patients go to their prenatal appointments and provides transportation when necessary. It also offers Suboxone, which Beese said is safe to take during pregnancy and breastfeeding.

Beese said shame often prevents pregnant women who struggle with addiction from getting prenatal care early in their pregnancy. They worry they’ll be judged by their medical provider or their baby will get taken away by the Department of Social Services.

“Recovery doesn’t get easier just because you have a baby,” Beese said. “They deserve care too.”

In Robeson County, UNC Health Southeastern has a doctor who specializes in pregnant women struggling with addiction.

One in every four pregnant patients at the hospital, which has several satellite offices across the county, has been diagnosed with an opioid use disorder, McKinley said.

Helping others

Healthy Start helps connect women in Robeson County with resources across the region and provides transportation, said Erica Little, the program coordinator.

In 2019, when Sampson’s child stopped breathing and needed to be induced, a Healthy Start worker drove her to the hospital. In 2021, when Sampson got pregnant with her third child, the program connected her with a provider who prescribed anxiety medication.

“Even though I’m saying our county has a biased way of looking at people, Healthy Start is in our community,” Sampson said. “They do not treat you with the same bias our community has. They’re trying to overcome the bias in our county.”

Because of her experience with Healthy Start, Sampson has become an advocate for pregnant women.

Sampson said a pregnant 17-year-old came to her after being disowned by her mother and kicked out of her church choir. Sampson helped the girl get a job at a local boutique, where she became employee of the month. Since then, the girl has gotten engaged and found a new job.

“I was so proud of her,” Sampson said.

Sampson also encourages her sixth-grade students at Deep Branch Elementary School and her youth group at Deep Branch Missionary Baptist Church to talk about sex education. She carries around a few brochures about the free services at Healthy Start, just in case.

“Never let guilt and shame prevent you from getting the health care you need,” Sampson said.

The post More pregnant women need prenatal care in North Carolina’s Border Belt. But how? appeared first on North Carolina Health News.