Georgia Tech teams with ‘big data’ experts to study medical imaging

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.”

Feds report serious RN shortages at many Georgia nursing homes

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.

Three sisters do their part for Georgia’s longevity tradition

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!”

Students from Douglas County win anti-opioid video contest

Georgia Health News, 05.31.2018

Students from the Douglas County College and Career Institute are the winners of the “We’re Not Gonna Take It” video contest.

The contest is a chance for Georgia students to make PSA video and audio clips related to the opioid crisis, which will be aired on television and radio stations across the state.

A recent Kaiser Family Foundation analysis, citing CDC statistics, reported that Georgia had 918 opioid overdose deaths in 2016 and 1,394 drug overdose deaths overall. But those figures could be underreported.

State Attorney General Chris Carr, who announced the winners, says that last year, an average of four Georgians died per day from opioid-related overdoses.

The name “opioid” means “like opium.” Opioids are a group of drugs — some natural and some synthetic, some illegal and some used for medical treatment of pain — that work on certain brain receptors and can be highly addictive.

The contest, which began Feb. 1, is open to high school and college students enrolled at a Georgia-based school. This year, the contest was looking for submissions that “highlighted the dangers, risks and consequences associated with opioid misuse and abuse, that availability of resources and/or the 911 Medical Amnesty and Expanded Naloxone Access Law.” Video and radio submissions were accepted.

Chancellor Newsome, MaKayla Tappin, Casson Thompson and Jace Swafford created the winning video, which focused on the effects of teen use of opioids, under the guidance of an instructor, Nicole Oliver Rivers.

Douglas County CCI, established in 2009, is a joint venture between the high schools in Douglas County, West Georgia Technical College and the Douglas County Chamber of Commerce. The goal is integrating “core academics and advanced career/technical education programs, thereby encouraging high school students to achieve at a high level and to seamlessly begin to pursue post-secondary studies.”

In 2016, the CCI offered full-time enrollment for students for the first time, and 204 students applied and 60 ninth-graders were chosen by a lottery process.

“A good storyteller captures their audience, stimulating their emotions, while leaving them with something to think about,” said Gary Morris, principal of the Douglas County school. “In the words of Pablo Picasso, ‘action is the foundational key to all success.’ This group of students has stepped up and taken action to deliver a meaningful and powerful message that illustrates the dangers, risks and consequences associated with opioid misuse and abuse.”

Students at Bainbridge High School received the first runner-up prize, followed by students at Gainesville High School, whose video was second runner-up.

“The Office of the Attorney General and our partners want to thank all students who submitted entries for the ‘We’re Not Gonna Take It’ video contest,” said Carr in a statement. “It is critically important that we continue to engage our youth as we work to strengthen our state’s response to the opioid epidemic, and we want to congratulate the students of the Douglas County College and Career Institute, Bainbridge High School and Gainesville High School for their leadership, dedication and creativity.”

In sponsoring the contest, the Office of the Attorney General partnered with the Georgia Association of Broadcasters, the Healthcare Distributors Alliance, the Medical Association of Georgia’s “Think About It” campaign, the Georgia Pharmacy Association, the Kennesaw State Center for Young Adult Addiction and Recovery, the Georgia Prevention Project, the Council on Alcohol and Drugs, and the Georgia Council on Substance Abuse for the contest.

Below is a link to the winning video.

Jail Deaths in Georgia: Pleas for help end in tragedy

Atlanta Journal Constitution, 05.18.2018

Suicides are a leading cause of jail deaths in Georgia. The stories of Kimberly Clements and Demilo Glover were among the 168 cases documented in the AJC/Channel 2/News Lab investigation.

‘Let the bitch kill herself’

Kimberly Clements, a 30-year-old wife and mother, told people she couldn’t survive jail.

Clements was on probation for writing bad checks when authorities arrested her on charges of theft and property damage on July 21, 2011.

She told a fellow inmate and a probation officer the next day that she’d kill herself if she had to stay behind bars, according to a federal lawsuit and investigative records. When Candler County Sheriff Homer Bell heard his inmate was suicidal, he responded: “Let the bitch kill herself,” according to investigative and court records.

Jailers placed Clements alone in a cell. Hours after she threatened to kill herself, inmates found her dead. She’d hung herself from a shower curtain rod. When an emergency medical crew arrived, they found Clements in her cell, cold and blue, lying in what appeared to be a puddle of water with flies hovering around her open mouth.

In their wrongful death lawsuit, her family accused the sheriff and one of his jailers of failing to follow jail policies to protect people from self-harm. An expert witness for the family said it was the most brazen failure he’d ever seen of jail leadership’s responsibility to protect people in custody, including those at risk of suicide.

“They just put her in there … and let her be,” said Clements’ mother, Linda Jenkins.

The family eventually reached a settlement. In 2015, Bell retired after 34 years as sheriff. In a recent interview, he said of the inmate who died on his watch: “She was high on dope and we had her in the holding tank and she hung herself is all I know.”

 — Naomi Thomas, News Lab

‘Breakdown’ in a Savannah jail

On his first attempt to hang himself at the Chatham County Jail in 2017, records show Demilo Glover’s noose gave way and he tumbled onto his cell bunk.

A minute later, he reattached the noose and tried again. This time the noose held.

Even though surveillance video inside the jail’s medical unit captured both suicide attempts, jail staff failed to intervene, records show.

Staff responded after they spotted Glover’s motionless body on surveillance monitors, but by the time they entered his cell, it was too late.

Glover’s arrest eight days earlier for drunken driving and other traffic violations set in motion a series of bizarre and troubled behavior that ended with his death.

Glover suffered from bipolar disorder, according to family. Several days into his incarceration, staff heard Glover talking to himself, according to investigative records. He told them he saw a little boy with a can of green beans who would not leave him alone.

Staff transferred Glover to mental health observation in the medical unit, where policy required a check every 15 minutes. Medical staff told investigators Glover was crying and asking for his medication. Another time, they said he “took off his jumpsuit, bent over in front of the (surveillance) camera, slapped his butt, and said, ‘you can all kiss my ass.’”

Glover’s girlfriend, Carol Brown, visited him just days before his death. She said he told her the medicine he was receiving in jail “wasn’t doing him any good.” Glover was “nervous and jittery” and wanted to go home.

Brown said she attempted to give jail staff a list of his medications, so that he “wouldn’t have a breakdown.”

“They wouldn’t accept anything,” she said.

For Brown, the grief can seem overwhelming.

“I miss him every day,” she said. “I’m stuck and I can’t move forward, but I try.”

 — Avery Braxton, News Lab

When inmates die: Georgia’s jails fail mentally ill

Atlanta Journal Constitution, Contributor, 05.18.2018

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

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.

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.

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.

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.”

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.

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.

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.

‘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.

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.

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.”

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.

“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.”

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.

‘Dashboard’ spells out the health of 500 cities – including several in Georgia

atldowntown-640x300Georgia Health News, 05.18.2018

Andy Miller and Naomi Thomas

How healthy is your city?

A newly released “City Health Dashboard’’ tracks 36 measures affecting health for the 500 largest U.S. cities – those with populations of about 66,000 or more.

In Georgia, 11 cities were measured on factors ranging from education and poverty to their rates of chronic diseases and their walkability.

The report was produced by the New York University School of Medicine’s Department of Population Health.

“What we’ve tried to do is bring together measures of health and drivers of health to motivate change and health improvement,” said Dr. Marc Gourevitch, of NYU School of Medicine.

“A number of education factors are key to producing health later on in life,’’ he said, adding that “poverty is just a huge driver of health outcomes.’’

Unlike some other data reports on the health of places in the United States, the Dashboard is strictly informational and does not try to “rank” cities for better or worse. But a review of several factors studied showed that the cities of Sandy Springs, Roswell and Johns Creek – all in northern Fulton County in the Atlanta suburbs – generally had Georgia’s most favorable scores on the health factors, including low levels of uninsured people and premature deaths.

Still, the suburbs are not without problems. The data show that Johns Creek is below average on access to healthy food, and it has a relatively high rate of binge drinking.

Johns Creek, Sandy Springs and Roswell also have low “walkability” scores, meaning they don’t make it easy enough to be a pedestrian and get exercise safely on foot. Atlanta and Savannah are the most walkable Georgia cities.

Atlanta has a high rate of children in poverty, at 38.1 percent, while it has roughly average percentages of adults who are smokers and who are physically inactive, and of adults accessing dental care.


Diabetes rates among the 11 cities range from a low of 7.2 percent of adults in Sandy Springs to a high of 16.7 percent in Macon. (Here’s a link to the Dashboard.)

Among other findings:

** Augusta has a relatively low number of premature deaths. But 35 percent of residents are obese, and one-third are physically inactive.

** Macon has one of the highest rates of obesity, at 40 percent of adults, and it also has one of the lowest scores for park access and walkability. Macon has the highest percentage of uninsured people, at 25 percent, and 43 percent of its children are living in poverty.

** Athens has a high level of children in poverty, at almost 40 percent. But it rates low in premature deaths. Warner Robins has a rate of children living in poverty of 34.5 percent, and 35 percent of adults are obese. But its uninsured rate is below that of several cities.

** Savannah has a high rate of breast cancer, cardiovascular and colorectal cancer deaths.

**Columbus has a high rate of cardiovascular disease deaths and of premature deaths.

** Albany and Columbus have a much higher rate of teenage births than the average city.

** Albany has very poor scores on several measures. Almost half of its children live in poverty. Forty percent of adults are obese. About one-fourth of adults are smokers. And its adult diabetes rate of 15 percent is much higher than the U.S. city average of 9.8 percent.

The measures uses data from several national sources, including the U.S. Census and the CDC, as well as state figures.

The findings from the City Health Dashboard can be useful, said Dr. Harry Heiman, a health policy expert at Georgia State University’s School of Public Health.

Dr Harry Heiman

“Anything that creates an opportunity for a city to look at [health] indicators, why they are positive or negative outliers, can be valuable,’’ he said.

Improving health factors for a city “is all about leadership,’’ Heiman added.

But some health measures rely on action at the county or state level, he said. Health improvement “will require actions on all levels.”



Sexual assault and PTSD: What’s being done for survivors

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.

Agony of endometriosis leaves many women feeling alone

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.’ ”


Atlanta mayoral candidates tap city vendors, businesses for donations

AJC, 10.20.2017, Contributor

Posted: 2:46 p.m. Friday, October 20, 2017

The federal investigation into pay-to-play contracting at Atlanta City Hall hasn’t shut down the steady flow of cash from city vendors to the campaign accounts of people trying to succeed Kasim Reed and become the city’s 60th mayor.

Companies and individuals with a stake in city business have donated hundreds of thousands of dollars to the major candidates, according to an analysis of campaign disclosure statements by The Atlanta Journal-Constitution and Georgia News Lab.

The list of contributors includes vendors and concessionaires at Hartsfield-Jackson International Airport, contractors with the city’s public works department and others that provide services to the city.

A complete accounting of the donations is difficult because of loose reporting rules that have allowed unchecked errors and omissions made in the campaign filings by many of the leading candidates.

But an analysis of city vendors found hundreds of donations from individuals who work for companies that have had a financial relationship with City Hall. Some vendors also gave directly to the candidates.

To identify city vendors, the AJC and News Lab analyzed a database of city payments from 2010-2014 and contracts of $1 million or more awarded from 2015 to early 2017. The list includes some companies that have done relatively little business with the city.

This week at a public forum, candidate Peter Aman alleged that one-third of the donations collected by councilwoman Keisha Lance Bottoms came from airport contractors. The AJC/News Lab analysis could not confirm that figure, but found some of the biggest players in airport contracting have thrown support to Bottoms, who has been endorsed by Mayor Reed.

Bottoms, who has been forced to return $25,700 in donations from an airport vendor tainted by the contracting scandal, said she hasn’t counted how much airport money has been given to her campaign, but said “it’s unfortunate that Peter is trying to make the ethical issues surrounding the procurement process my issues when they are not.”

Without naming names, Aman also alleged that his campaign was promised the financial support of some contractors if he agreed to help his “friends” upon taking office. Aman said he declined the offer.

Other candidates, such as Mary Norwood and Ceasar Mitchell, also have received city contractor money, including airport vendors, the analysis found. Aman’s campaign includes a $1 million personal loan and contributions from financial services companies, major corporations and law firms.

There are many reasons companies and individuals contribute to campaigns that have nothing to do with winning contracts or getting public money. Many that do little or no business with the city can be found in the campaign disclosure reports, including Coca-Cola, Home Depot and Cox Enterprises, the parent company of the AJC.

Employees with Cox Enterprises and its subsidiaries donated to most of the major candidates.

Billions in contracts over next four years

The issue of vendors trying to influence the election is important, because for the third time in a generation Atlanta voters will elect a new mayor with a federal bribery investigation hanging over City Hall.

In the current scandal, two contractors have pleaded guilty to bribery and the city’s former purchasing chief, Adam Smith, has admitted to taking $30,000 to influence procurement. Earlier this month, a federal prosecutor said corruption in Atlanta was “prolific.”

The government’s investigation is ongoing, and likely to stretch into the next administration.

Meanwhile, the new mayor will preside over billions of dollars in contracts during the next four years, spreading taxpayer money from airport concourses to MARTA tracks, and hundreds of miles of streets, sidewalks and sewers in between.

Most of the major candidates have used the scandal to take tough stances on procurement reform and ethics, including several calls to halt approval of contracts that expire next year, so they are not awarded until the new administration takes over. But that hasn’t stopped the flow of money from city vendors and contractors.

And that should surprise no one, said Emory University political science professor Michael Leo Owens.

“It’s in their interests to demonstrate some support,” Owens said of city vendors. “In the case of the candidates, every damn dollar matters to them.”

The general election is Nov. 7, and the race is likely headed to a run-off — which will require even more fundraising by the top two finishers.

Spreading money across the board

Some of the city’s largest contractors have given generously, with many of them contributing to multiple candidates.

One of the largest African American owned construction companies in the country, H.J. Russell & Company, has been a player in political campaigns for decades. And this year is no different.

People associated with H.J. Russell and another family company, Concessions International, have spread $23,700 around to eight candidates: Lance Bottoms ($10,100), Mitchell ($4,250), Aman ($2,500), Norwood ($2,500); John Eaves ($2,000); Vincent Fort ($1,250); Kwanza Hall ($1,000); and Cathy Woolard ($100).

Chief executive Michael Russell said the family has “many qualified friends … running for political office this year, which we individually and collectively support.”

“In regard to donations … my siblings and I make our own decisions based upon our own points of view,” Russell said. “Sometimes our company will make contributions. I care strongly about the future of Atlanta. So I believe it is important to participate in civic affairs and the political process.”

Hojeij Branded Foods, which claims on its website to be the “largest operator” of restaurants at Hartsfield-Jackson International Airport, has provided more than $64,100 to five candidates. Most of the Hojeij family money has been reserved for Bottoms ($40,900) and Mitchell ($13,500), although councilwoman Norwood also received $6,000 and Hall $3,600.

A public relations firm representing Hojeij said none of the family members would answer questions for this story.

The airport money is also flying in from out of town.

Master ConcessionAir, a Miami-based company that owns or operates dozens of restaurants in seven airports, sent all of its money to Bottoms.

Eleven people associated with the company donated a combined $23,525. One of the Master ConcessionAir donors, Pedro Amaro Jr., gave $5,100, according to Bottoms’ campaign disclosures.

Those involved in an earlier incarnation of the company came under federal investigation in 2002 for allegedly receiving $1.7 million from a Miami airport vendor to meet federal minority-business requirements while not actually opening a restaurant. No charges were ever filed in the case. MCA still operates in Miami and now does business at the Atlanta airport.

Messages left for Amaro at the company’s Miami office were not returned. The Atlanta phone number was unable to accept messages.

Developer Egbert Perry’s company, which is in a dispute with the Atlanta Housing Authority over an option to purchase vacant property held by the authority, also donated to multiple candidates.

Employees with Integral Group, including Perry, the CEO, are backing Aman, Eaves, Fort, Hall, Mitchell, Norwood and Woolard for a total of $13,600. The next mayor will make appointments to the AHA board.

Other companies that have contracted with the city and given to multiple candidates include C.D. Moody Construction Co., Heery International, Jacobs Engineering and SD&C Inc., a city sidewalk vendor.

Sara Henderson, executive director of Common Cause Georgia, called generous donations from contractors to political campaigns “the foundation of pay to play.”

“It’s something voters should think about,” she said. “Unfortunately, it seems like just another day in Atlanta.”

Norwood, Mitchell top fundraisers

Norwood has consistently led in public polling, but she is second in money raised from outside sources, having collected $1.3 million to Mitchell’s nearly $2 million. Mitchell boosted his total with a $150,000 personal loan to give himself more cash-on-hand down the stretch.

Three of Norwood’s top 10 donors are employees of Atlanta law firms that often provide legal services to the city, including Smith, Gambrell & Russell; Alston & Bird; and King & Spalding.

Norwood also received donations from real estate companies and developers who have an interest in residential and commercial building, and a smattering of construction companies who contract with the city.

About 20 percent of Norwood’s campaign money came from Buckhead zip codes, which is where she lives. She said having concentrated fundraising in Buckhead does not indicate weakness in other parts of the city.

Norwood ran for mayor in 2009, losing to Reed in a razor-thin runoff election.

“Fundraising this time has been extraordinarily difficult for everyone because there have been so many candidates in the race,” Norwood said. “We know that I have strong support in Buckhead. I think it’d be pretty startling if I didn’t have strong support from my home community.”

Mitchell, who paid an $8,000 ethics fine this year for failing to disclose up to $93,000 in expenses during his campaign for council president, has parlayed his long law career into vast support in the legal community.

An attorney at DLA Piper, one of the world’s largest law firms, Mitchell’s campaign has received $28,952 from co-workers at the firm.

Mitchell’s disclosures show at least 495 donations totaling more than $251,637 from people who self-identified as working in the legal profession. He also had 703 contributions for $445,700 from out-of-state donors.

Some of that out-of-state fundraising happened during events in far-flung places like Maine, Colorado, Las Vegas and New Orleans.

“It’s called going to where you know you have relationships,” Mitchell said of his out-of-state travel. “It’s called tapping into those relationships that you have. And that’s what I think I’ve been very successful in doing.”

Aman, Bottoms, Woolard top $1 million

Overall, Aman has raised the most money in the race, thanks to the strength of his personal bank account.

Without the million-dollar loan, Aman’s fundraising would be barely over $1 million and almost exactly on par with Woolard, a former council president and lobbyist.

Aman leaned heavily on his Rolodex of Atlanta’s high-powered CEOs, financial services companies and former colleagues at Bain & Company, the consulting firm where he worked for 30 years. People tied to Bain ponied up $68,583. Those with Cox Enterprises, the parent company of Cox Media Group, which operates the AJC, gave Aman $27,701.

Prior to running for mayor, Aman served as the city’s chief operating officer during the first two years of the Reed administration, and was an advisor to Mayor Shirley Franklin before and after she took office.

Aman is the only candidate to make a loan to his campaign who has pledged to not pay himself back with future fundraising if he wins the election. He said the money he put into his campaign is a dollar-for-dollar match with his supporters’ contributions.

“I’m contributing to my own campaign because I’m trying to keep up with lifelong politicians that have built vast networks of fundraisers,” Aman said. “So whether it’s Mary Norwood or Ceasar Mitchell or Keisha Lance Bottoms, they all have pyramids of contributors.”

Aman also received nearly $6,000 from employees of Equifax, the credit rating agency that suffered an enormous data breach that resulted in the personal information of 140 million Americans being stolen. He returned $3,600 from former CEO Rick Smith after criticism from his opponents.

Bottoms is another candidate who has made loans to her campaign, amounting to $240,000. She downplayed the significance of city contractors in fundraising.

“Contractors, like all citizens, have a right to give,” she said. “I think you have to look at the donations and see if there are any expectations attached to them. This is my fourth election and I’ve never been accused of improprieties. It’s never been a problem.”

Bottoms was the biggest offender when it came to not identifying where her donors work, with employer information missing for about 20 percent of her donors.

While Bottoms’ campaign drew significant support from city vendors, Woolard built her campaign war chest among academics, lawyers, human rights groups and health care professionals.

Woolard’s donor list is heavy with people from Emory University and Georgia State; Grady Health System; people supporting the LBGT community; environmental groups; the health care industry; and a few law firms. Employees with Cox Communications and Cox Automotive, subsidiaries of Cox Enterprises, gave Woolard $13,715.

“We’ve got about 2,400 individual donors,” Woolard said. We’ve been executing on our plan and…we do events every night of the week. That’s where Peter and Keisha are so vulnerable: They’ve got money, but they don’t have (voters) behind it.”

Hall, Fort, Sterling and Eaves

Four candidates have not broken the $1 million mark in their fundraising, and that group is led by councilman Kwanza Hall, with $622,000. Hall has a smattering of contractors in his reports, but by far the largest group of donors identify themselves as retired or self-employed. As of his October disclosure, Hall had $241,000 on hand and he said that’s plenty to finish the race and qualify for the runoff.

“There have been some limitations in terms of the number of available dollars” in the race, Hall said. “I think donors have become extremely fatigued. But we still see a clear path to victory and we’re working day and night.”

Fort, a former state senator, has run a populist, Bernie Sanders-style campaign. In fact, the presidential candidate and Vermont senator has endorsed Fort and held a rally for him in Atlanta.

Candidates are not required to identify donors who give campaigns less than $101, and Fort has a ton of them, which his campaign has valued at a combined $291,407, or about 60 percent of his $481,000 total.

Other candidates have identified those small donors on their reports even though they don’t have to. When asked why he chose not to, Fort said there were simply too many.

“I have almost 10,000 donors, and some of them have given $1, $5 or $10 dollars,” Fort said. “I would be printing a phone book.”

Fort has also drawn heavily from municipal unions and from his former colleagues at the Legislature, including former Gov. Roy Barnes and his law firm for $8,000.

Michael Sterling, an attorney and former director of the city’s workforce development organization, and Eaves, Fulton County Commission chairman, combined have raised less than Fort.

Sixty-four percent of Sterling’s money has come from out of state — his girlfriend is an actress and model in Los Angeles and has helped him raise money there — and includes contributions from lawyers, medical professionals and consultants.

Eaves’ support is largely corporate, from the likes of Delta Air Lines, the Greenberg Traurig law firm and Home Depot.

Eaves was the last candidate in the race, and said his name-recognition will allow him to be competitive with less money.

“When I ran as chairman of Fulton County in 2014, I got 82,000 people in Atlanta to vote for me,” Eaves said. “We think that no more than 80,000 people are going to vote in this race coming up. You’ve got 12 or 13 candidates, and the margin of victory for the second-place winner may be 12,000 votes. We can outperform candidates with $2 million.”

Newsroom data specialist Jennifer Peebles contributed to this report.

Nine candidates, $9 million raised

The nine major candidates are ordered by the total amount raised, including loans. Top contributors are aggregated totals from businesses and individuals who work for the same company, along with related persons.

  • Peter Aman: Total raised: $2.1 million; Loans to self: $1 million; Out-of-state percentage: 9 percent; Top contributors: Bain & CompanyCox EnterprisesAlston & Bird.
  • Ceasar Mitchell: Total raised: $2 million; Loans to self: $150,000; Out-of-state percentage: 24 percent; Top contributors: DLA PiperTroutman SandersGreenberg TraurigHojeij Branded Foods.
  • Mary Norwood: Total raised: $1.3 million; Loans to self: $0; Out-of-state percentage: 3 percent; Top contributors: King & SpaldingBranch PropertiesAlston & Bird.
  • Keisha Lance Bottoms: Total raised:$1.1 million; Loans to self:$240,000 ($50,000 repaid); Out-of-state percentage:24 percent; Top contributors:Hojeij Branded Foods, Master ConcessionAir,H.J. Russell & Company/Concessions International.
  • Cathy Woolard: Total raised:$1 million; Loans to self:$0; Out-of-state percentage:21 percent; Top contributors:Emory University,Georgia State University,Cox Communications.
  • Kwanza Hall: Total raised:$622,000; Loans to self:$0; Out-of-state percentage:15 percent; Top contributors:LAZ Parking, Rajeev and Sanjeev Kaila, Kandi Burruss-Tucker, Brian and Laura McNamara.
  • Vincent Fort: Total raised:$481,772; Loans to self:$0; Out-of-state percentage:16 percent; Top contributors:Former Gov. Roy Barnes/Barnes Law Group,Ronnie Mabra,State Sen. Steve Henson.
  • Michael Sterling: Total raised:$228,162; Loans to self:$0; Out-of-state percentage:68 percent; Top contributors:OPI Construction, Sidney Austin, Global Green USA.
  • John Eaves: Total raised:$205,147; Loans to self:$0; Out-of-state percentage:11 percent; Top contributors:Bronner Bros./Noble Rock,Vantage Private Capital,Greenberg Traurig.

Source: AJC/News Lab analysis of Campaign Contribution Disclosure Reports.

How we got the story

Reporting for this story began when journalists at the Georgia News Lab, an investigative reporting partnership with Kennesaw State University, the AJC and Channel 2 Action News, sought to digitize campaign contribution reports from the candidates running for Atlanta mayor. News Lab students first attempted to obtain digital reports from the private vendor paid by the city to maintain the data, and had to seek help from the Attorney General’s office when the vendor declined to provide them. In the end, students had to work off of PDFs and convert them to a data set that could be searched an analyzed. AJC data specialist Jeff Ernsthausen helped clean and prepare the data for analysis, along with help from data specialist Jennifer Peebles. AJC investigative reporter Dan Klepal interviewed candidates about the reports, along with students when possible. AJC reporter J. Scott Trubey also assisted with the reporting, and Klepal wrote the story. News Lab journalists helping with the story were: Ryan Basden (Kennesaw State University); Avery Braxton (Mercer University); Jenna Adalane 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 Cornell Mays (GSU); Chad Rhym (Morehouse); Naomi Thomas (UGA, graduate student); Dominique Times (GSU); Savannah West-Calhoun (Clark Atlanta University); Harrison Young(UGA).