Georgia Health News 08.21.2018

“Big data’’ health care analytics are the focus of a new program at Georgia Tech.

Last week, the American College of Radiology’s Harvey L. Neiman Health Policy Institute announced a five-year, $3 million research partnership with the Georgia Institute of Technology to establish the Health Economics and Analytics Lab (HEAL), with the Ivan Allen College of Liberal Arts at Georgia Tech.

HEAL will apply big data analytics and artificial intelligence to large-scale medical claims databases — focusing on medical imaging — to better understand how health care delivery and payment models affect patients and providers.

“The goal of the HEAL lab is ultimately just to provide objective, credible scientific evidence into the national medical imaging debate,” said Danny Hughes, executive director of the Neiman Institute and professor of economics in the School of Economics, a unit of the Ivan Allen College of Liberal Arts.

Using big data analytics, the HEAL lab will look at “the broader view of policy as it impacts the medical profession,” said Hughes, “but we are primarily focused on understanding that from the viewpoint of medical imaging,” such as X-rays, MRIs and CT-scans.

Large data analytics is a hot topic in health care.

“Big data analytics is a term that means examining or analyzing a large set of data in some way in order to be able to make meaningful conclusions about the information,” said Lesley Clack, an assistant professor in Health Policy and Management and the University of Georgia’s College of Public Health.

Hughes, who will lead the lab, describes data analytics as “examining the wealth of patient data out there to see if there are any insights that can better inform patient care, better structure, or add better structure to health care systems.” Analysis of vast quantities of data may reveal subtle patterns that even the sharpest medical professionals would not notice on their own.

He uses the example of a patient suspected of having had a stroke. Data analytics can be used to look at the treatment model for that patient. Data from a number of factors related to the treatment can then be used to look at a larger set of patient outcomes in the same category, and determine whether any treatment guidelines need to be changed. The goal is to make treatment as cost-efficient and beneficial to each patient as possible.

“In health care, data analytics is used to allow companies and organizations to make better decisions,” said Clack. “Administration may use data for strategic planning. Clinical departments use data for disease management and making clinical decisions. Finance departments use data for assisting with claims processing.”

Data sets are already in use by organizations such as the Neiman Institute, a boutique health policy think tank founded in 2012 and based in Washington, D.C.

“On our website,” said Hughes, “in addition to providing research, we actually provide data tools where we’ve taken data and we’ve packaged it up, we’ve cherry-picked and put it in a way that’s accessible to people and put it on maps you can find online.”

One example is the Neiman Almanac, which provided data that the state of Hawaii used on imaging guidelines for patients.

The HEAL lab came into being after a lengthy process. Hughes was the first research director at the Neiman Institute, which he said is committed to “understanding everything within the world of policy and economics as it pertains to medical imaging.”

In 2016, the institute felt that it would be able to leverage its resources better if it was embedded within a larger institution and had access to a greater set of skills.

“We are involved in bringing that credible objective data into the debate,” said Hughes, “And so sometimes you need an expert in epidemiology, sometimes you need an expert in computer science, and that’s not something that every study you need requires.”

“We felt that perhaps if we linked with more of an academic-based enterprise, we could actually leverage into a larger cross-section of talent,” said Hughes.

After a search, the Neiman Institute decided that Georgia Tech was the perfect match.

“Georgia Tech has a really strong public policy presence, their engineering is world-class,” said Hughes, “and the one thing that Georgia Tech bought to the table and that we saw at very few other institutions was a firm commitment to interdisciplinary research between departments. And that’s the world that we are in.”

Large-scale data analytics, and the work done at places such as the HEAL lab, can help shape the future of health care.

“Instead of relying on years of accumulated physician specific experience,” said Hughes, “if you have all of that patient data in databases of millions of patients data, then hopefully we can discover those non-intuitive patterns that can better optimize care, better optimize treatment pathways, better optimize the system as a whole so that we can really maximize outcomes with a minimum of resources and really harnessing large-scale data is what’s going to make this happen.”

Georgia Health News, 07.30.2018

Andy Miller

An analysis of Medicare data shows that nearly half of Georgia nursing homes recently were found “below average’’ or “much below average’’ in their staffing levels of registered nurses.

RNs are the highest-trained caregivers required to be on staff in a nursing home, and they supervise other nurses and aides. Medicare mandates that every facility have a registered nurse working at least eight hours every day, Kaiser Health News reported this month.

Of Georgia’s 346 nursing homes that were rated, 163, or 47 percent, received “much below average” or “below average” ratings of RN staffing based on Medicare data from January through March of this year, as reported by KHN.

Medicare rates RN staffing based on the average number of hours worked by registered nurses and nurse administrators for each resident. The ratings range from “much below average” to “much above average.”

Medicare recently began collecting and publishing payroll data on the staffing of nursing homes as required by the Affordable Care Act, rather than relying as it had before on the facilities’ own unverified reports, Kaiser Health News reported. Payroll records revealed lower overall staffing levels  than facilities had indicated, especially among RNs, KHN reported earlier this month.

Melanie McNeil, Georgia’s long-term-care ombudsman, told GHN on Monday that she wasn’t surprised by the staffing findings.

“Not enough staff is a common concern that ombudsman representatives hear from residents, family and sometimes even staff,’’ she said.

“RN staffing is important because direct-care workers may notice changes in a resident but they don’t have the training that RNs do to recognize what the change means and what action to take,’’ McNeil said.

“For years, advocates have been urging specific staffing ratios for direct care workers and nurses, including an RN 24 hours a day,’’ she added. “As a state, we should provide more incentives for individuals to enter these professions, including better wages and tuition forgiveness.”

Kaiser Health News also reported Monday that Medicare lowered its “star’’ ratings for nearly 1,400 nursing homes nationally because they either had inadequate numbers of RNs or failed to provide data proving sufficient nurse staffing.

Of the facilities downgraded to 1 star, 27 were in Georgia, but KHN said it’s not immediately apparent whether they were downgraded because of RN levels, or because of the other possible reasons — that they didn’t submit data or that the government couldn’t verify their data.

Earlier this year, nursing home care emerged as an explosive issue in the state. An 11Alive Investigation (by Atlanta’s WXIA) uncovered the 2015 death of 93-year-old Rebecca Zeni, a northwest Georgia nursing home resident killed by scabies infestation.

On June 4, 2015, a report by the Georgia Department of Public Health revealed that Zeni was one of 35 residents and staff infected with scabies in the Shepherd Hills Nursing Home in LaFayette. Last month, state lawmakers and top health officials held a special meeting in response to the scabies report.

The Georgia Health Care Association, a nursing home industry trade group, said in a statement Monday to GHN that the Medicare staffing methodology is flawed and misleading, adding that it makes things look worse than they are.

“The current methodology underreports staffing,’’ said Devon Barill, an association spokeswoman. “For example, for employees who are salaried and work more than 40 hours in a week, [Medicare] does not count hours beyond 40 per week unless the salaried employee is paid an additional amount above their usual salary, even when it is widely known that many nurses work extra shifts and thus extra time.’’

She added that Georgia nursing homes face a statewide shortage of RNs, so they keep higher levels of licensed practical nurses (LPNs) on staff. But the federal Centers for Medicare & Medicaid Services (CMS) does not count some of those LPN hours worked, such as supervisory hours, Barill said.

“Collectively, this results in fewer hours of patient care being reported today than actually delivered and certainly less than previously reported. As such, we don’t feel that the new ratings provide an accurate reflection of the care being provided in Georgia’s centers.”

“We also believe that judging the quality of a nursing home based solely on staffing is misguided,’’ Barill added. “There are centers with high staffing levels and poor outcomes and numerous deficiencies and there are centers with low staffing with good inspection reports and good quality outcomes.”

Nearly 1.4 million people are cared for in skilled nursing facilities in the United States. When nursing homes are short-staffed, nurses and aides scramble to deliver meals, transport bedbound residents to bathrooms and answer calls for pain medication, KHN reported. Essential tasks such as repositioning a patient to avert bedsores can be overlooked when workers are overburdened, sometimes leading to avoidable hospitalizations

“We’ve just begun to leverage this new information to strengthen transparency and enforcement with the goals of improved patient safety and health outcomes,” the CMS said in a statement to KHN.

Kathy Floyd of the Georgia Council on Aging said Monday that ‘’the lack of RNs has caused some homes to give more duties and responsibilities to LPNs. But you have to make sure they have the necessary training and, of course, that [instruction] takes time away from direct care.”

Overall staffing levels are low, Floyd added. “Advocates and providers are talking about possible solutions to Georgia’s lower staffing levels. I hope our next governor will look at provider reimbursement rates and please, please tie increases to quality measures.”

The new payroll data, analyzed by Kaiser Health News, showed that for-profit nursing homes averaged 16 percent fewer staff than did nonprofits, even after accounting for differences in the needs of residents. The biggest difference was in the number of registered nurses: At the average nonprofit, there was one RN for every 28 residents, but at the average for-profit, there was only one RN for every 43 residents.

The data also revealed that nursing homes have large fluctuations in staffing. The average nursing home had one licensed nurse caring for as few as 17 residents or as many as 33, depending on the day. On the best-staffed days, each certified nursing assistant or other aide cared for nine residents, but on the worst-staffed days, each aide was responsible for 16 residents, KHN reported.

Weekend staffing was particularly sparse. On weekends on average, there were 11 percent fewer nurses providing direct care and 8 percent fewer aides, according to the KHN report.

McNeil, the long-term care ombudsman, said that including the nurse staffing information in the nursing home ratings “is helpful for individuals to consider when choosing a nursing home.’’

The Georgia Health Care Association cited consumer satisfaction surveys conducted by NRC Health, in which the trade group said  93 percent of nursing center residents and their families indicated they would recommend Georgia skilled nursing care centers to friends or relatives in 2017.

“The cost of direct care staffing for Georgia’s skilled nursing centers still exceeds what Medicaid currently reimburses, so centers are unable to compete with the wages and benefits packages of other health care provider groups and non-health care employers,’’ Barill added.  The Georgia Health Care Association, she said, “continues to work with legislators and other stakeholders to address these issues and develop methods to enhance the ability of Georgia’s nursing centers to recruit and retain a skilled, competent workforce.”

GHN intern Naomi Thomas contributed to this article.

Georgia Health News, 06.25.2018

Springfield Baptist Church in Sparta recently played host to a celebration for three local sisters — Tennie S. Henderson, 103, Lillie S. Lewis, 100, and Julia S. Williams, 98 — who have continued the state’s recent history of very old residents.

Two Georgia supercentenarians (people who have lived to or passed the age of 110) made headlines in recent years. Besse Cooper, a Monroe resident who spent most of her life in the small town of Between, was the world’s oldest person at the time of her death in 2012 at age 116. Dr. Leila Denmark, a legendary pediatrician and researcher, died in Athens that same year at age 114.

More recently, the Mangham siblings of Pike County have earned a spot in the Guinness Book of World Records as the five oldest siblings in the world.

The sisters honored in Sparta, known as the Skrine sisters for the surname they had before their marriages, have joined this longevity list.

The United States had more than 71,000 centenarians in 2015, but that represented only 0.022 percent of the population.

Sheila Davis, the daughter of Lewis, carried out some research trying to confirm the family’s thinking that they were the oldest sisters in the state. She called senior citizen agencies in Georgia trying to find an older set of sisters, and she was not able to track down any.

The sisters were born and raised in the Springfield community of Hancock County, which is where all three returned to live out their retirement years. Henderson and Lewis now share a residence, and Davis helps to care for them. Williams lives with her daughter.

Healthy living

The three sisters were all accomplished seamstresses from their youth. While Lewis and Williams went to school at Savannah State and majored in home economics, Henderson traveled farther, moving to New York, where she initially used her sewing skills working in the garment district. Later, she and her husband opened a dry cleaning business, and they worked side by side for 45 years until retirement.

While their oldest sister was working in New York, Lewis and Williams both became teachers. After finishing their education, they came back to Sparta to begin their careers. Both taught in elementary schools. Williams is retired from the Greene County school system and Lewis is retired from the Hancock school system.

“She also coached basketball for about 37 years,” said Davis of her mother. “She was my basketball coach.”

The sisters were also active in their local church, leading Vacation Bible School and singing in the choir “until they got of age,” said Davis, “and could no longer do all that kind of stuff.”

All three sisters had husbands and children, and all three are now widows. (Women far outnumber men in the ranks of the very old.) Henderson’s 82-year-old daughter still lives in New York. Lewis and Williams both married fellow teachers and had four and three children, respectively.

The sisters lead less active lives now than they once did, mainly getting their recreation by watching TV. But though they’ve slowed down, Davis says, “they get around pretty good.” Williams uses a cane, Lewis a wheelchair and Henderson a walker.

“My mother loves doing the word search puzzles,” said Davis. “She still does that sometimes, not as much as she used to, but she still does do it sometimes.”

The sisters believe there are a few reasons why they have lived so long.

“The oldest one [Henderson] always says that she had a good husband,” said Davis, “and she doesn’t have hardly any wrinkles, and she says it’s because she didn’t have a husband who worried her to death.”

“The other ones, they always say that they had a good upbringing,” said Davis. “They raised everything they ate.” Their father was a successful farmer, and all the sisters’ food when they were growing up had been grown by the family.

The healthy way of eating that began in their youth is something the sisters believe played a role in their longevity.

“And they never smoked,” said Davis. “And they never drank!”

Georgia Health News, 05.31.2018

Atlanta Journal Constitution, Contributor, 05.18.2018

By Brad Schrade , Jennifer Peebles and Georgia News Lab Staff – The Atlanta Journal-Constitution

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The Muscogee County Jail in Columbus had three inmates die over a two-week period in 2013. One of the inmates, Lori Carroll, ‘literally beat herself to death in front of’ jailers, according to her family’s attorney. NICOLE CARR / CHANNEL 2 ACTION NEWS

Posted: 6:00 p.m. Friday, May 18, 2018

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In Lori Carroll’s final hours, as her psychotic behavior spiraled out of control, no one at the Muscogee County Jail helped relieve her suffering.

Carroll, 46, had a history of mental illness and had spent multiple stints behind bars for theft, shoplifting and forgery. In her last arrest, officers in Columbus charged her on the morning of Oct. 22, 2013, with disorderly conduct after she harassed drivers at a local school. Police took Carroll to jail after she refused a hospital mental health evaluation.

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Lori Carroll died in 2013 after two days in the Muscogee County Jail. Carroll was mentally ill and imagined people were … Read More

Over the course of the next two days, Carroll’s condition worsened in the isolation of cell HD-13. She screamed repeatedly and pounded her fist on the cell door. She spoke to imagined people and thought a man was trying to rape her. She struck her head against a wall and a metal bunk, investigative records show.

On the morning of Oct. 24, less than nine hours after a jail doctor placed Carroll on suicide watch, a guard discovered her cold and stiff on the cell floor. Her mouth and eyes were open. Cuts and bruises covered her body. A state medical examiner noted a serious head injury, broken ribs and a collapsed lung that killed her.

“It was like something out of a horror movie,” said Justin Blake Toland, Carroll’s adult son. “She didn’t deserve that. No one does.”

Gaps in the criminal justice and mental health systems have turned local jails into warehouses for the mentally ill, often with fatal consequences.

The Atlanta Journal-Constitution, Channel 2 Action News and the Georgia News Lab conducted one of the most comprehensive reviews of jail deaths ever undertaken in Georgia, reviewing the deaths of more than 500 inmates and detainees in the state’s local jails in the past decade. The investigation found:

• One in six deaths attributable to something other than natural causes involved inmates who exhibited signs of mental illness. The deaths were often preventable. Jail staff routinely didn’t recognize threats and warning signs until it was too late, ignored or expressed indifference to an inmate’s crisis or failed to keep troubled inmates under close observation.
• Thirty of the 168 jail suicides examined by reporters involved inmates where signs of mental illness were noted in public records or press accounts. But the number of these deaths linked to mental health is likely significantly higher. Studies estimate 90 percent of people who commit suicide suffered mental illness.
• The 16 homicides accounted for just a fraction of all jail deaths. But nearly half of those involved inmates who exhibited signs of mental illness.
• No single state or local agency in Georgia tracks how many people die in jails each year or the details of the cases, and federal statistics routinely  undercount Georgia’s jail deaths. There’s little analysis to inform policy discussions and promote training that could prevent jail deaths.

Protecting and treating the mentally ill behind bars is something jailers have struggled with for decades. The federal Justice Department has estimated that nearly two-thirds of all local jail inmates have mental health problems. The prevalence of inmates with a mental illness in Georgia jails seems to have increased over the past decade as the state closed psychiatric hospitals, said Terry Norris, executive director of the Georgia Sheriffs’ Association.

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J. Terry Norris, executive director of the Georgia Sheriffs’ Association, says the closure of psychiatric hospitals in Georgia has increased pressure … Read More

Norris said responsibility now falls to community treatment programs — and the state’s 143 county jails.

“Unfortunately, our county jails have become the primary providers of mental health services for many of our state’s most vulnerable citizens,” he said.

Sheriffs do the best they can with finite local resources to manage this troubled population, he said.

In Carroll’s case, despite her serious injuries, repeated screams and bloodied face, jail guards and medical staff never sent her to a hospital for treatment. The jail’s protective restraint chair, designed to stop inmates from harming themselves, sat unused. Guards and medical staff couldn’t agree on who should make the call to restrain her. They also failed to use less restrictive methods to protect Carroll from self-harm.

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Lori Carroll, right, with her son, Tim Chestnut, died in the Muscogee County Jail. She hallucinated in her isolation cell and … Read More

Toland and his half-brother sued the county government, jailers and its medical providers alleging willful indifference and a flawed policy that failed to protect the mentally ill. A federal judge dismissed the case against the government and its employees, but last December Carroll’s sons settled with the medical providers.

“It was one of the worst cases in terms of neglect I’ve ever seen,” said Craig Jones, the family’s attorney, who has litigated dozens of jail death cases. “She literally beat herself to death right in front of them.”

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Newton County jailers found Jade Tramel hanging from this bed sheet in March 2014. They cut him loose, but could not … Read More

A suicide on cell block C-1

Jade Tramel didn’t hide his intention to leave the Newton County Jail on his terms.

Authorities arrested the 18-year-old Dec. 3, 2013, for marijuana possession, driving on a suspended license and burglary. Shortly after his arrest, Tramel’s mother, Melanie, said she called jail officers to warn them her son was suicidal.

Just weeks into his confinement, a jail staff member found Tramel eating a bar of soap. Officials placed him on suicide watch. Tramel told Sheriff Ezell Brown and others he was depressed and wanted to end his life, according to allegations in a federal lawsuit.

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Jade Tramel died in March 2014 after he hung himself from a bunk in the Newton County Jail. Tramel told jailers … Read More

A few weeks later, after he moved off suicide watch, Tramel tied a bed sheet to his cell bunk and tried to hang himself. When guards found him unconscious, the sheet around his neck, authorities rushed Tramel to a nearby hospital. Doctors revived him, treated him and sent him back to jail with instructions to prescribe anti-depressants and place him on suicide watch.

A month later, after Tramel received mental health treatment, a jail doctor cleared him to leave suicide watch a second time and return to a regular cell.

On the evening of March 19, jail managers assigned a jail recruit to supervise the overnight shift on housing block C-1.

The recruit was just weeks into his training with the sheriff’s office and hadn’t yet earned his state certification. No one informed him about Tramel’s troubled history or the previous suicide attempts, a lawsuit alleges.

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Newton County jailers found Jade Tramel hanging from this bed sheet in March 2014. They cut him loose, but could not … Read More

Tramel seemed fine when the recruit spoke to him before the 11 p.m. lockdown, investigative records show, and nothing seemed amiss during the recruit’s initial hourly bunk checks.

Around 1:15 a.m., the recruit made his second round of checks. When he peered through the narrow window in Tramel’s jail cell, he saw Tramel alone, hanging from a bed sheet tied to the top bunk. By the time guards cut Tramel down, it was too late. Tramel was again taken to the hospital, but this time he couldn’t be revived.

An internal investigation into his death by the Newton County Sheriff’s Department found no policy violations, but investigators noted that recruits who have not received jail certification or completed field training should not be left to supervise an entire housing unit.

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‘He was screaming for his life’

Estimates of mental illness among jail inmates vary across the country, from 20 percent up to 60 percent of inmates.

The issue has received renewed focus as the number of jail suicides has hit record numbers across the country in recent years. In 2015, the suicide of Sandra Bland in a Texas jail drew protests, forced discussion about jail suicides and led to reform.

Currently, no one tracks how many Georgia jail inmates have a mental illness. The sheriff’s association is trying to develop a program to count them, document jail deaths and collect other data that can inform the state’s sheriffs tasked with operating county jails.

Five jails from large counties accounted for nearly a third of all deaths identified in the news investigation.

Fulton topped the list with 55 inmate deaths. DeKalb was second with 34 deaths, including the 2015 case of inmate Donte Wyatt, who authorities allege killed his cellmate and ripped out his eyes.

Wyatt, who had been in jail on murder and rape charges, was on mental health lockdown just days before jailers placed him in a cell with Jah’Corey Tyson. Wyatt strangled Tyson in the middle of the night and stabbed him with a sharpened toothbrush, according to court records.

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Jah’Corey Tyson was killed by his cellmate in the DeKalb County Jail in 2015. The man, who exhibited signs of mental … Read More

After killing Tyson, Wyatt ate one of his eyeballs and wore the other around as a necklace until he was convinced to give it up, according to a federal lawsuit. The suit alleges jail guards failed to heed warnings about Wyatt’s deteriorating mental state leading up to the attack. Once he went after his cellmate in his sleep, guards ignored Tyson’s pleas for help, the lawsuit alleges.

“He was screaming for his life,” his mother, Cassandra Tyson, later said.

The other jails in the top five for inmate deaths, include Chatham County Jail in Savannah (26), Cobb (22) and Gwinnett (19), according to the news analysis.

A couple years ago, the Floyd County Jail in Rome faced what Sheriff Tim Burkhalter viewed as a crisis.

One inmate had committed suicide during his first 12 years in office. When two inmates killed themselves in 2016, it caused Burkhalter to re-examine how his jail was managing at-risk inmates.

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Floyd County Sheriff Tim Burkhalter became alarmed after two inmates killed themselves in his jail in 2016. He hired a suicide … Read More

Burkhalter hired a suicide prevention expert to help revamp training, change the detainee intake process and refocus efforts to monitor inmates deemed suicidal.The changes have made a difference. The jail staff prevented 21 suicide attempts last year and agency leaders said the staff is more confident to manage inmates on the brink.

“Mental health is a real issue in our jails,” said Sgt. Carrie Edge, who helps teach the agency’s suicide prevention class. “Our training has helped to change attitudes and increase awareness about suicide risk, and made our staff more prepared.”

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An arrest spirals downward

After decades of serious mental health and physical conditions, medication offered a lifeline for Wickie Bryant.

Growing up in Atlanta, she dreamed of becoming a psychiatrist. But mental illness in her early 20s dashed that hope. A series of jobs and a winding journey through Georgia’s mental health system followed. Medications helped manage her schizophrenia, bipolar disorder, depression, hypertension and diabetes.

Still, with all her troubles, Bryant remained close to a supportive family.

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Wickie Bryant died in 2015 at the Atlanta City Detention Center. Her family alleges the city jail neglected her and she … Read More

“She was just a ray of sunshine,” said her older sister Mildred Sims, who raised Bryant after their mother died at age 45.

In 2015, Bryant went missing from her group home in Atlanta.

“We just really nearly went crazy because we didn’t know where she was,” Sims said.

Officers arrested Bryant on a disorderly conduct charge that September after Sims reported her missing. When she was booked into the Atlanta City Detention Center, a medical screening identified her mental and physical ailments, but that did little to stall a rapid decline.

Bryant refused testing to monitor her blood-glucose level and wouldn’t take insulin. About a week after her arrest, she requested the jail medical staff obtain her medical history and prescribe medication to help manage her schizophrenia and depression. According to the lawsuit, none of that happened.

Over the next week, Bryant continued to neglect her medication, even though Sims said she told jail staff about it and they assured her they would monitor it.

She spent a few weeks in the special needs section of the jail, but on Oct. 5, she was transferred to maximum security. Cell 202, where she was held in isolation, was unlit. In that environment, her mental and physical health deteriorated. At one point, a jail officer found Bryant lying naked in bed and mumbling incoherent thoughts, the lawsuit alleges. Another time a jailer found feces in front of her cell.

On Oct. 13, an inmate noticed Bryant hadn’t touched her food. She laid in bed and said nothing. When the inmate tried to relay her concerns to guards, they ignored her, the lawsuit alleges.

Guards checked on Bryant several times that afternoon. The last time, hours later, they saw dried vomit covering her face. The reek of urine filled the room.

“I got this call that she was deceased,” Sims recalled.

Her sister had suffered a diabetic coma. The federal lawsuit alleges willful indifference on the part of the city’s jail supervisors and staff. It criticizes inadequate policies to manage and maintain the health of mentally ill detainees.

Sims thought her sister was safe in jail because it had medical staff.

“I felt relieved she was no longer on the streets,” she said.

Sims is left with memories and daily prayers for her sister.

“From my heart, I know she’s in a safe place now,” she said. “But it still doesn’t stop the pain.”

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Jail deaths in Georgia, 2008-2018

_{*Mental illness is not a cause of death. Mentally ill inmates are included in all of the causes of death categories.
Source: AJC/Channel 2/News Lab analysis of state and local jail death records.}

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About the story

The Atlanta Journal-Constitution, Channel 2 Action News and the Georgia News Lab collaborated on this story. The News Lab, based at Kennesaw State University, is an investigative reporting project of Georgia’s leading college journalism programs, in partnership with the AJC and Channel 2. The partners compiled 10 years of jail deaths from state and county medical examiner records, death certificates, autopsies and case files from the GBI and other agencies. The AJC’s Jennifer Peebles built the database with technical expertise from Jeff Ernsthausen. Reporters flagged cases for mental illness after reviewing case records. Reporters interviewed jail officials, investigators, attorneys, mental health and correctional institution experts, and family members of deceased inmates. AJC investigative reporter Brad Schrade assisted with reporting and wrote the story. News Lab reporters were: Ryan Basden (Kennesaw State University), Avery Braxton (Mercer University), Jenna Eason (Mercer), Hannah Greco (Georgia State University), Nate Harris (University of Georgia), Victoria Knight (UGA, graduate student), Ayron Lewallen (Morehouse College), Christina Maxouris (GSU), Michael Mays (GSU), Chad Rhym (Morehouse), Naomi Thomas (UGA, graduate student), Dominique Times (GSU), Harrison Young (UGA).

Georgia Health News, 03.10.2018

I used to have nightmares actually, about a shadowy figure that would stand over my bed,” said M, “and it was shaped like my assailant.”

M, a college student in Georgia, is a survivor of sexual assault. She has experienced PTSD since the attack a year ago. She has been taking medication and going to therapy to help with the symptoms.

Post-traumatic stress disorder (PTSD) has been discussed for decades as a problem for war veterans. But it is also one of the most common psychological effects seen in survivors of sexual assault.

According to the National Center for PTSD, symptoms include repeated thoughts of the assault, memories and nightmares, and attempts to avoid thoughts, feelings and situations related to the assault. Examples of this include difficulty sleeping and concentrating, jumpiness and irritability.

A study by the National Violence Against Women Prevention Center at the Medical University of South Carolina found that almost one-third of all rape victims developed PTSD at some point during their lives. Rape victims were 6.2 times more likely to develop the condition than non-victims of crime. The center says that if 13 percent of American women have been raped, and 31 percent of these women have developed PTSD, then 3.8 million adult American women have rape-related PTSD.

“When my therapist first told me I had PTSD, I thought she was nuts,” said Susan Lee, who lives in New Jersey. “I was like, ‘You’re out of your mind, the only people that get PTSD are like in the military, they’ve been shot at and stuff.’ ”

Lee is a survivor of sexual assault. After around 30 years of not dealing with her assault, she went to therapy. It was there that she was diagnosed with PTSD and started her journey of healing.

Lee and M are just two of the many survivors who suffer from PTSD and its related symptoms.

Lee now works as a board moderator for Pandora’s Project, a nonprofit online organization offering peer support, information and resources to anyone who has been affected by sexual violence. This is done using tools such as message boards and chat rooms.

“I could be anywhere, I could be walking down the street,” Lee said. “I heard a laugh or some man walked past me and smelled like one of them, it’s visceral, it brings it all back to you.”

Music can be triggering for M. Popular music that degrades women is one of the things that troubles her most.

But sometimes it’s not the content of a song but the memories linked to it. “There’s songs that my rapist and I used to listen to,” she said, “and I still have trouble listening to them in the same way.”

This is just one of the societal factors that can be triggering for survivors.

Coping with PTSD was hard for Lee. The first time she talked about her assault was when she went to therapy for all the “difficult symptoms I was dealing with at the time.”

Lee credits her therapist with helping save her life. She, like some other survivors, had started to self-medicate to deal with her trauma. Luckily, she pulled herself out of this spiral with the therapist’s help.

“Being attacked in such a personal way, such an intimate way, it touches every aspect of your life,” she said, “and you have to learn how to manage that.”

Therapy helped her to do this. Although it was a financial burden, it was worth it.

The cost of therapy and access to help can be problems for some survivors.

“I think it could be a lot better, to be completely honest, especially for people who don’t have insurance,” said M. “I know if I didn’t have insurance, I wouldn’t have been able to afford it.”

The cost of therapy can be high, and sometimes survivors can’t afford it. This can lead to survivors leaning on each other, as was the case with M and one of her friends.

As everyone experiences trauma differently, those working in the field understand that each client has to be approached differently. Some of the less traditional methods used are art therapy and yoga therapy.

Survivors can also find sources of comfort in places which aren’t necessarily psychologically or medically based, such as animals.

“I’m really into animals, so I always go out to a stable somewhere with horses, or find my friends’ dog,” said M, “just whenever I’m feeling down.”

“The main thing I strive to do differently is I empower them from the get-go,” said Stacy Sampson. She has been a licensed professional counselor (LPC) in Georgia since 2012. Much of her work involves trauma victims, many of whom are survivors of sexual violence.

Sampson, who practices in Athens, rarely works with a client for less than a year and she is used to tailoring her sessions to fit the needs of the patient.

“It’s like a kitten has played with a ball of yarn,” she said. “I’m just pulling on bits of yarn with the client choosing which parts of the yarn they’re pulling out to figure out what’s connected to what.”

Although therapists in this field have to be wary of things such as secondary trauma, the benefits of her chosen field are clear to Sampson.

“I’m able to understand that my part in the situation is to help the person heal,” said Sampson, “and to be able to frame it that way for myself, I’m able to not allow that person’s trauma to soak into me, but for me to be in that role of helping that person heal and manage PTSD symptoms.”

Her ability to do this is evident from the colorful array of thank-you cards displayed on the wall of her office.

Some suffer in isolation

Although working with therapists and counselors has proven beneficial to many survivors, not all of them are even aware that they can, or should, seek out this help.

“There are plenty of people who think they are fine, but really they aren’t fine,” said Sampson.

Trying to deal with these symptoms alone, or without treatment, can make them worse.

Along with some survivors not being aware of the psychological effects they may face, the general public can also have a lack of awareness. There can also be uncertainty about how trauma victims present themselves.

“I think people have this concept of this crying, wrapped-up-in-the-corner person, and there are tons and tons of people that look perfectly fine,” said Sampson, “but they are actually navigating trauma, they are just doing it with a smile on their face.”

“I’m not sure if people truly get how deeply it can affect you,” said Lee.

The social stigma that can still be associated with sexual assault can create a new problem for survivors. At times, it can hinder their recovery and ability to seek out psychological help.

“I think, in our culture, sex in general is taboo. We don’t feel comfortable in general talking about sex and so the idea of nonconsensual sex or assault, because that’s what it is, is even more taboo,” said Hannah Quackenbush, “because it’s an added level of violence and aggression and its scary, so people are really uncomfortable talking about it.”

Quackenbush is a social work graduate student at the University of Georgia and interns at The Cottage, the sexual assault and children’s advocacy center in the Athens area. She sees the value of mental health and psychological work that can be done to help survivors of sexual assault, and plans to stay in the field once she has graduated.

For M, the conversation around sexual assault must continue to grow to help erase the stigma.

She wants to see “more open conversation about it and more guys seeing like, ‘Hey, rape jokes aren’t funny,’ and ‘Hey, this really affects people,’ and ‘Hey, this isn’t a good thing that happens in our society,’ ” she said, “I think if we increase conversations, it will help.”

Quackenbush believes that sexual assault survivors have to face two major hurdles when seeking help: Talking about sexual assault and talking about mental health.

“I think it takes a lot of courage to seek out services,” said Quackenbush. “We stigmatize therapy and we stigmatize any type of services that has to do with the psyche. That is weird to us . . . we are terrified of it, we don’t want to talk about it.”

“I think there’s just a stigma that you’re crazy and you let it happen and it’s your fault,” said M. “And that’s not OK, because you’re already” struggling with those same misguided feelings of guilt.

She believes the stigma around both sexual assault and mental health can worsen PTSD. Not having the support of those around you can make these issues a lot harder to deal with.

“I think people don’t realize how much a woman has to lose by coming forward,” she said, “because she’s risking her career, her physical health, her mental health.”

Although there is still this stigma around sexual abuse, Lee, Sampson and Quackenbush all think the situation is improving.

“I’d like to think the conversation is growing more and people are getting more educated about it,” said Lee.

Recent celebrity revelations and social media campaigns are helping to widen the conversation and the scope of public knowledge.

With “this #MeToo campaign, and celebrities that are coming out and saying, ‘Hey, I experienced this and here’s why it was hard for me to say what happened,’ ” said Quackenbush. “I think we’re growing in awareness. I don’t know if we can take this abstract celebrity experience and put it into our everyday lives, but I hope we can. It would be really beneficial.”

Social media campaigns are not the perfect way to address the problem. To some they can be problematic. Sometimes people who feel victimized point fingers at each other for alleged complicity in an abusive sexual culture. However, these campaigns do have benefits.

“This #MeToo campaign is upsetting a lot of people,” said Lee, “but it’s also empowering, I think.”

Lee believes that this campaign could help to change public opinion on sexual violence. She also believes it creates a space where those who could have felt unable to talk about their trauma can have a voice.

With increased public perception and acceptance of the conversations that need to be had around sexual assault, and with more understanding of the mental health problems that survivors have to confront, there is hope that more survivors will be able to get the psychological assistance they need. And there will always be passionate professionals there to help them.

“I love this work, and it’s really weird to say that, because when someone calls or knocks on the door, its usually not for a great reason . . . but I thoroughly enjoy being able to help and assist in whatever way I can,” said Quackenbush.

Georgia Health News, 12.07.2017

Ashley Coleman’s hands shake as she sits down. Her period ended the day before, and she is still feeling the effects. This is the first day she has been up and about since it started.

She isn’t “lazy,” she says, but dealing with the situation is not as simple as it is with most women.

She has endometriosis.

Coleman had her first period when she was in fifth grade. It lasted for 30 days. And as she got older, things got worse.

Due to a maternal family medical history, her mother and grandmother took her to the doctor with hopes of getting her tested. Unfortunately, medical professionals thought she was too young to have the disease.

She had to suffer for years before she was finally diagnosed with endometriosis. The diagnosis came after she had surgery. Doctors later described the appearance of her uterus as reminiscent of  “tree rings.”

Endometriosis is defined as what happens when the lining of the uterus grows outside of the uterus.

“It’s hard to live,” said Coleman, who is now 21 and living in Athens. “I’m living, but I feel like I’m not living how I’m supposed to live.”

It’s estimated that more than 6 million in the United States suffer from the condition. Although knowledge of the disease is increasing among the public, due to media reports and celebrity awareness, it is still fairly unknown and often misunderstood.

One reason for that is its varying effects.

“We can . . . easily define it as a disease characterized by the presence of endometrial-like tissue found outside in other areas of the body,” said Heather Guidone, the Surgical Program Director at the Center for Endometriosis Care in Atlanta.

“The disease manifests differently in different folks,” said Guidone, “so I may have certain symptoms, like just painful periods, you may have periods that are painful but not debilitating, yet you might have significant bowel symptoms.”

Although there is range of symptoms, Guidone says signs that can help point toward diagnosis include painful intercourse, pelvic pain at any point in the cycle, gastrointestinal pain and bladder dysfunction.

Sadly for many women with the disease, a definitive diagnosis often takes time.

“There’s a lot of multi-faceted aspects to the delayed diagnosis,” said Guidone, “we lack an accurate awareness and early understanding.”

She believes that physicians can all too easily dismiss a lot of the warning signs of endometriosis. Doctors sometimes ignore complaints or regard them as just normal discomforts, creating a huge delay is diagnosis.

“We really need to improve the health literacy, not just for physicians to take the disease seriously, but also for women to feel empowered about their own symptoms,” she said.

Women reaching out

The endometriosis community is trying to work to improve the knowledge and awareness of the disease. Coleman is active and passionate about fundraising and building awareness of the campaign.

“I want to be the voice for the people, so they know they aren’t alone,” said Coleman.

Unfortunately, there is no cure for endometriosis.

“I tell people it’s like having weeds,” said Coleman, “you can clean it all up, but they come back.”

Still, it is a condition that can be managed. Laparoscopic surgery is required for diagnosis, and there are medical and alternative therapies that some people will try with help from women’s centers or specialized physical therapists.

One of these treatments is pelvic floor therapy. The Center for Endometriosis Care often refers its patients to pelvic floor therapy after surgery as they may have problems with the muscles inside the pelvis. Pelvic health therapists evaluate the issues that are activating and causing pain for endometriosis sufferers and then develop treatment programs to help overcome this.

“The emphasis should always be on the most effective, least amount of surgeries,” said Guidone, “you want someone who is going to go in and diagnose the disease, and also treat it in the same encounter.” This treatment is called a laparoscopic excision, what Guidone calls the gold standard for treatment.

Along with the pain that women go through with endometriosis, there’s often a feeling of isolation. Those with the disease can feel cut off from relatives and friends, who sometimes don’t understand the seriousness of what is going on.

“If you tell someone enough times the pain is in their head, then they start to believe it and they may self-isolate,” said Guidone

“I’ve lost friends because of it,” said Coleman. “They got tired of me not being able to go and hang out with them.”

Christine Ward of Savannah was diagnosed with endometriosis in 2009. She doesn’t enjoy life as she once did, and she can relate to others’ complaints about a feeling of isolation.

“I used to love going to the park with my son, or going to do stuff, and we rarely do that now,” she said, “and it’s a terrible thing.”

Because of the isolation and depression felt by some endometriosis sufferers, Ward made the decision to start Ask Endo Girl, a Facebook page that could act as a community and support group for, what she calls, “endo sisters.”

“I wanted to just create an outlet where we could just be ourselves and endo girls can just speak freely,” she said, “and just be a community, because we don’t really have that.”

Like Coleman and Guidone, Ward stresses the importance of support for women living with endometriosis. Her online group and others like it are places where these women can get that.

“It’s just important to know that you’re not alone, and I just wanted to create that environment,” said Ward.

Living with endometriosis is a constant struggle. It’s not something that women with normal menstrual cycles can easily identify with.

Coleman recalls what she heard in school health classes about the effects of puberty: “It’s going to be great, you’re going to have a period and you’re going to be a woman finally.”

Unfortunately, her own experience has proved much less positive. “It’s like ‘Mom, this isn’t great at all, this isn’t fun.’ ”