Two Rivers Public Health Department and Governor Pete Ricketts Respond to Mayor Stan Clouse Criticism of Withholding Information

KEARNEY – Governor Pete Ricketts recently signed an executive order that allows local health departments to release information about known coronavirus cases for the protection of first responders. Kearney Mayor Stan Clouse says that the Two Rivers Public Health Department is not releasing information to the city and he says that this lack of information does not help first responders. Mayor Clouse says that they have been denied on numerous occasions by the director and the board. He said they offered to place stringent controls to respect the privacy of the people affected. They want the information so it can be included in their 911 system. He said that this “makes it very hard to manage a crisis when additional information is withheld by an organization that is not held accountable at any level.” Governor Ricketts responded to this at his daily coronavirus briefing. 

So first of all, I would say to first responders, you should prepare, that every household you go to, that some body there has tested positive for the coronavirus.

He also said that, at the end of the day, it is up to the local health departments to release this information or not.

The Two Rivers Public Health Department also responded to their withholding of information about coronavirus patients with this press release:

Two Rivers Public Health Department has received multiple requests to share information with dispatchers, emergency responders, and law enforcement about positive COVID-19 patients.  After thoughtful discussion, input from multiple public members, and deliberations, the Two Rivers Public Health Department Board of Health has made a policy decision to not release protected health information.  TWO RIVERS PUBLIC HEALTH DEPARTMENT will continue to perform contact tracing with individuals who have tested positive for COVID-19, and provide recommendations about when an individual is able to complete isolation. Operating on a good faith belief, TWO RIVERS PUBLIC HEALTH DEPARTMENT honestly and sincerely does not believe the disclosure of confidential information will prevent or lessen imminent threat to first responders or the public.  

“We strongly encourage individuals who are experiencing COVID-like symptoms to report these symptoms when utilizing emergency services.  Likewise, we encourage any person experiencing illness to stay home and limit contact with others,” states Jeremy Eschliman, Health Director at Two Rivers Public Health Department.

Some identified concerns are:

  • Only lab-positive cases are shared with TWO RIVERS PUBLIC HEALTH DEPARTMENT and tracked by the organization, which is known to be a small percentage of contagious individuals based on current research, investigations, and other data. 
  • Cases in which the individual is solely diagnosed by a medical professional, and not lab-tested, are not shared with TWO RIVERS PUBLIC HEALTH DEPARTMENT or tracked 
  • There is no timeframe for recovered COVID-19 cases to ‘fall off’ of the list, leading to lasting stigma
  • There are a tremendous number of asymptomatic positive cases 
  • There are individuals who choose to self-quarantine due to symptoms associated with COVID-19, without ever seeking testing or diagnosis, and which would not be shared with TWO RIVERS PUBLIC HEALTH DEPARTMENT or tracked. 
    • In addition, TWO RIVERS PUBLIC HEALTH DEPARTMENT is operating at maximum capacity currently, and creating a new reporting system would significant decrease needed resources for contact tracing. 

TWO RIVERS PUBLIC HEALTH DEPARTMENT continues to advise that emergency responders use universal precautions on ALL calls to best protect themselves.  TWO RIVERS PUBLIC HEALTH DEPARTMENT had provided significant stocks of PPE to emergency responders throughout the district with this in mind.  

For more information call Two Rivers Public Health Department at (888) 669-7154 or visit www.trphd.org

 

The Two Rivers Public Health Department also sent this letter to County Attorneys, County Sheriffs, City Attorneys, City Managers, and City Police Chiefs:

I have received multiple requests to share information with dispatchers, emergency responders, and law enforcement about positive COVID-19 patients. Specifically requested were addresses and/or names of patients who have tested positive for COVID-19, or are presumed to be positive for COVID-19. I have given these requests a great deal of consideration, have discussed them with the Nebraska Department of Health and Human Services and other local public health departments around the state, the executive committee of the TRPHD Board of Health, legal counsel, and have done some research into the state and federal laws regarding such information sharing. Ultimately the executive committee of the TRPHD decided that the Board of Health as a whole should make this decision, as it truly is a policy decision for the organization. 

The Board of Health met last night, on April 28, 2020 in a special meeting. The Board of Health had available to it the particular requests and proposals received by TRPHD, the April 4, 2020 letter from TRPHD on this issue, a letter from Dr. Gary Anthone dated April 17, 2020, Disclosure of Identifiable Health Information FAQs from the Department of Health and Human Services dated April 14, 2020, the Chief Medical Officer for the State of Nebraska, Executive Order 20- 15, information about the modifications to HIPAA by the federal government, and letters of support for the Buffalo County proposal from the Kearney Police Department and the Buffalo County Board of Commissioners. Board members requested and received input from individuals present at the virtual meeting. Board members also expressed their questions, concerns, and thoughts. The Board of Health ultimately voted to not share the personal and identifiable health care information of individuals as has been requested. 

My understanding from the nature of the conversation is that the Board had concerns about the following issues, although these are not intended to be an exhaustive list of their concerns. 

– The quality of the list would not be as useful to first responders as may expected 

because 

▪ Only lab-positive cases are shared with TRPHD and tracked by the organization 

▪ Cases in which the individual is solely diagnosed by a medical professional, and not lab-tested, are not shared with TRPHD or tracked 

▪ There is no timeframe for recovered COVID-19 cases to ‘fall off’ of the list 

▪ There are a tremendous number of asymptomatic positive cases 

▪ There are individuals who choose to self-quarantine due to symptoms associated with COVID-19, without ever seeking testing or diagnosis, and which would not be shared with TRPHD or tracked. – TRPHD is operating at maximum capacity currently, and doesn’t have the resources to  track or report out cases in greater detail than is currently being reported.

– The very real possibility that sharing of addresses would result in stigmatization and  discrimination against those who have tested positive for COVID-19 by members of the community, as has occurred historically with HIV/AIDS. – Dr. Anthone’s and DHHS’s guidance that disclosure of protected identifiable health  information be shared only when there is “a good faith belief that such use or disclosure would prevent and lessen a serious and imminent threat” to health and safety. Although COVID-19 is certainly a serious threat, it is not necessarily imminent where PPE is available and appropriately utilized by first responders. – There was no good faith belief that sharing the types of information requested would actually prevent or lessen the threat, due to the fact that with first responders that have been exposed to COVID-19, the exposures came from individuals with no known history of COVID-19 diagnosis or isolation/quarantine at the time of exposure, or were exposed through inadequate precautions taken even when PPE was available and universal precautions have been advocated through TRPHD unified command. – The DHHS guidance was that information released be “the minimum information necessary” relevant “to the immediate care of a patient and ensures proper safety precautions for the first responder,” and that “[i]nformation shall only be shared on a need to know basis, which means that any specific information on COVID-19 positive households or individuals, and that the confidentiality and privacy concerns found in Nebraska law were not suspended by executive order, which provided a very limited exception to the general rule of non-disclosure – Concerns that sharing such information may actually result in reduced quality of care from insufficient staffing on units if the status of patients as positive for COVID-19 were known. – The DHHS guidance was that first responders treat every address as a potential COVID-19 positive site. And as before we do make the following recommendations to first responders. Maintain a minimum distance of 6 feet from members of the public whenever possible. When not possible, wear PPE when coming into contact with all members of the public, regardless of their COVID- 19 status. Appropriate PPE for first responders includes mask, disposable gloves, and eye protection. In certain circumstances gowns may also be appropriate. 

At this time, TRPHD is not aware of any shortages or deficiencies in PPE amongst medical providers or first responders within the district. If you are aware of shortages or deficiencies, please contact me immediately, so that we can remedy the situation. We have supply of (PPE) that can be distributed to law enforcement and first responders. If you would like to make such a request, contact your local emergency manager, who will then forward the request to TRPHD, or my office. We also have staff that can provide instruction and guidance on wearing PPE appropriately. 

TRPHD has also worked with Tri-Cities Medical Response System (TRIMRS) and Good Samaritan Hospital on obtaining units to sterilize and decontaminate PPE, so we do recommend

 

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