There are more than just a few eyes on The Arc of the Central Chesapeake’s first major project on the Eastern Shore after the organization’s groundbreaking ceremony a few months ago on Port Street in Easton.

Excited by the prospect of not only a first-rate community resource center for The Arc’s traditional clients of those with developmental challenges and two floors of family-friendly affordable housing, the Port Street Commons represents a remarkable new step in creative solutions for the Shore’s accessible housing dilemma.

And given that general interest, the Spy asked The Arc’s Angie DeMoreland, its director of executive operations, and Ben Harries, founder and owner of BuilderGuru Contracting (BGC), one of The Arc’s longtime contractor partners, to give a update on the project. At a time when financing and supply chain challenges can severely set back timelines for any kind of construction, the good news is that Port Street Commons remains on target for a 2024 opening with no budget challenges.

This video is approximately five minutes in length. For more information about The Arc Central Chesapeake Region programs please go here.

During the pandemic, federal COVID relief packages distributed more than $4 trillion across the United States to counter the then-novel COVID-19 virus.

But over the course of several years, the Maryland legislature raised questions about how the state Department of Health documented and utilized some of the millions of dollars of federal COVID funding it received, but the state agency had few answers.

An audit released Tuesday found a “pervasive lack of documentation” regarding COVID funds and that the agency did not properly monitor how the state used millions of dollars during the public health emergency. The audit also identified questionable management of contractors engaged to help the department during COVID-19.

“I’ve never seen an audit like this. This is the worst audit I’ve ever seen. And it’s every worse nightmare pulled together,” said Sen. Clarence Lam (D-Howard), Senate chair of the Joint Audit and Evaluation Committee.

The review from the Office of Legislative Audits evaluated the finances of the Maryland Department of Health beginning February 12, 2019 through June 30, 2022, during the tenure of former Gov. Larry Hogan (R).

The audit found that during this time, the Maryland Department of Health “lacked assurance that the balances of the revenue and expenditure accounts related to federal fund activity were accurate.”

Auditors concluded that $1.4 billion in potential federal revenue is currently unaccounted for and requires a more comprehensive analysis to determine whether the state can be reimbursed for the expenses. The shortfall could exacerbate concerns about a tight budget in the upcoming fiscal year.

Lam explained that federal COVID funds typically work through reimbursements. States are told they have a certain amount of funding to use in order to perform a variety of responsibilities that helped keep people safe during the COVID-19 pandemic.

Typically, states would then ask to be reimbursed for those funds after spending them. But the audit shows that MDH “did not ensure that all provider payments were properly recorded in its automated system to enable recovery of federal funds to offset State-funded expenditures.”

The reimbursement issue was first raised in January in a report on the Statewide Review of Budget Closeout Transactions for Fiscal Year 2022. At that time, there was an estimated $3.5 billion shortfall.

“MDH subsequently advised that approximately $2.1 billion of this amount had been recovered as of April 2023, but that a comprehensive analysis of its accounts was needed to determine the ultimate collectability of the accrued revenue transactions,” auditors wrote.

Lam said the legislature asked the department for more information about pandemic spending, but received little documentation during the Hogan administration.

Moreover, MDH was not conducting adequate quarterly reconciliation to ensure that federal funds had been recovered, “resulting in failure to recover approximately $973.3 million in federal funds.” The Office of Legislative Audits raised this concern with MDH and the agency recovered most of the funds, but the “the untimely recovery resulted in lost interest to the State of $6.4 million.”

In December 2021, the Maryland Department of Health experienced a ransomware attack that affected the agency’s entire computer network and disrupted informational technology operations. The incident prolonged the auditing process and affected auditors’ ability to receive records. It also had an outsize effect on some state contracts.

Contracting concerns

The audit also notes that the state agency sometimes disregarded state procurement laws.

The audit says that an evaluation of one of the emergency contractors providing consulting services related to Maryland’s supply of COVID-19 vaccines revealed that the contract was modified to include “unrelated services without justification and did not sufficiently document if the services were received.”

The contract modifications were used to “circumvent state procurement regulation by increasing the scope and cost of the emergency contract without justification.”

The contract ballooned from just under $3.8 million in January 2021 to more than $87 million after a fourth contract modification nearly a year later.

Among the modifications were an expansion of the scope of the contract to include $40 million to support the ransomware response.

However, “MDH could not provide adequate justification for either modification, nor could it explain why separate procurements were not issued for these services given the nature of the new work, which appeared unrelated to the original COVID vaccination scope,” the audit said.

“Given the disparate nature of this activity compared with the scope of the original contract, we believe a separate contract should have been procured in conjunction with the Department of Information Technology and included consideration of information technology-specific vendors and consultants,” the audit said.

Lam said the audit amounted to lawmakers’ “worst nightmare.”

“It shows complete dysfunction and disarray when it came to properly accounting for funds,” during the pandemic spending boom, he said.

Ex-employees still receiving pay

The audit also identified that the health department did not have a system in place that would ensure former state employees were removed from  payroll, resulting in 45 employees continuing to receive payment even after leaving the job, totaling $151,000 of improper payment.

“MDH was unaware of this condition until we brought the matter to its attention in January 2023, and consequently, MDH had not yet taken action to recover the improper payments,” wrote auditors, who recommended additional evaluations to determine if there are more improper payments.

What’s next

The concerns raised by the audit occurred during the Hogan Administration, but the Moore Administration is left with fixing the issues.

“The audit… raises significant concerns about fiscal processes and controls, cybersecurity findings, and procurement processes,” according to a written statement from the current Department of Health. “In short, the report raises grave concerns about the stewardship of taxpayer dollars during a critical period for public health. The Department is moving swiftly to correct these issues using all tools available.”

The department has also hired an external accounting firm to help fix and improve the agency’s fiscal practices, and implemented an information security program to protect against future cybersecurity threats.

Lam said the health department and Maryland’s Secretary of Health Dr. Laura Herrera Scott have a lot of work to do to improve fiscal accountability and transparency.

“There’s a lot of work to be done here, and the new secretary needs to roll up her sleeves,” he said. “Really dig into this and make sure that the department has all the resources and personnel needed to make sure proper accounting takes place in the future.”

By Danielle J. Brown

Talbot Hospice proudly announces Molly Kirsch, BSN, RN as its new Executive Director. While this is a new role for Kirsch, she has more than a decade of leadership experience at Talbot Hospice, most recently serving as the organization’s Clinical & Operations Director where she helped shape a values-centric organizational culture built on compassion, accountability, respect and teamwork.

Kirsch assumes the top leadership position following the retirement of Chris Chekouras, who served in the role from 2020 – 2023. Over the past several months, Kirsch and Chekouras have worked closely together to ensure a seamless transition.

“It has been a privilege to serve Talbot Hospice and our community these last three years, and I cannot think of a better and more capable leader than Molly Kirsch to lead and shepherd our organization well into the future,” said outgoing Executive Director, Chris Chekouras.

“I am honored to continue my service to Talbot Hospice,” said Kirsch. “I was blessed to have Chris as a mentor, and I look forward to building on our mission and developing the talent we have to expand our reach in the community. We are fortunate to be supported by an active and engaged Board of Directors, dedicated volunteers and a philanthropic community that appreciates the need to make our services available to everyone wherever they call home, regardless of their financial circumstances.”

When asked about her goals, Kirsch pointed to increasing awareness of the full range of programs and services offered by Talbot Hospice – programs which would not be possible without the dedicated volunteers and generous donors that are paramount to implementing every aspect of Talbot Hospice’s mission.

“I want to learn from the community what they need from us and ensure that we are known not just for hospice care, but for the other care we provide, especially palliative care and our grief support programs.  Talbot Hospice isn’t about dying, it’s about living the life you want to live.”

Kirsch joined Talbot Hospice in 2010, first serving as the Director of the Eleanor A. Koons Hospice House where she was responsible for operational oversight and was then promoted to the Clinical & Operations Director overseeing hospice, palliative care, bereavement and volunteer services for in-home and residential patients. Before relocating to the Eastern Shore from upstate New York, she was the Lead Admissions RN and Liaison for Hospice Buffalo and a RN in the Intensive Care Unit at South Buffalo Mercy Hospital. Kirsch received her Bachelor of Nursing in 2022 from the University of Rochester and has continued her professional development.

Kirsch is active in the local professional community and is a member of the Shore Health System Hospice Consortium, Hospice & Palliative Care Network of Maryland and Alliance Kids.  Kirsch is also a graduate of Shore Leadership. She lives in Easton with her husband, Sean, and two sons, Finn and Logan.

 

The Clark Comprehensive Breast Center at University of Maryland Shore Regional Health (UM SRH) marked the beginning of October as Breast Cancer Awareness Month with a brief ceremony in front of the “pink ribbon tree” in the front circle of UM Shore Medical Center at Easton.

It also began this month with a powerful profile of Oxford’s Bonna Nelson’s breast cancer survivor story which can be viewed below:

 

The event was attended by providers staff members from the Cancer Center, the Breast Center and the hospital, as well as representatives from several community partner organizations. It began with welcoming remarks by Ken Kozel, UM SRH President and CEO, followed by a presentation on breast cancer rates and care provided by the Center’s Medical Director, Roberta Lilly, MD, and a testimonial by breast cancer survivor Bonna Nelson, of Oxford, Maryland.

In his opening remarks, Kozel thanked staff and providers of the Clark Comprehensive Breast Center, the Cancer Center and the Leh Women’s Center in Chestertown for their dedication to ensuring that women facing breast cancer in the five-county region have access to life-saving early diagnosis, state of the art treatment and social support strategies.

“Each year, this ‘pink ribbon tree’ – along with a variety of programs provided by the Breast Center team around the region — reminds our community of the importance of early, annual screening for breast cancer,” said Kozel.

Dr. Lilly offered several statistics highlight the breast cancer rates and treatment. She noted that breast cancer is the number two cause of cancer death among all women (and now the number one cause among black and Hispanic women), and that there are 4.1 million breast cancer survivors in the U.S. “Last year, we saw more than 2500 patients at the Breast Center – more than 500 were new patients — and provided over 16,000 mammograms,” she said. “We found 145 new cases of breast cancer.”

State of the art 3D mammography with tomosynthesis is provided at the Breast Center, at the Eleanor and Ethel Leh Women’s Center at UM Shore Medical Center at Chestertown, and in the UM Shore Medical Pavilions at Cambridge, Denton and Queenstown. Other diagnostic tools offered by the Clark Comprehensive Breast Center include ultrasound, magnetic resonance imaging (MRI) and needle biopsy.

In her testimonial, Nelson described the timely, comprehensive plan of care provided to her at the time of her breast cancer diagnosis, and her journey through surgery, radiation and chemotherapy. “We are very fortunate to have access to top quality cancer care here on the Eastern Shore,” she said. “On every step of my journey, I received so much compassionate concern and support from the physicians, nurses and others involved in my care.”

Nelson also expressed her appreciation for the benefits she gained from the YMCA of the Chesapeake’s LiveSTRONG program, which helps people experiencing or recovering from cancer treatment regain their strength, flexibility and confidence. 

The Clark Comprehensive Breast Center is offering a variety of programs during Breast Cancer Awareness Month, including three “Walk for Wellness” events (in St. Michaels, Denton and Easton) coordinated with the YMCA of the Chesapeake; and presentations on breast cancer prevention strategies and screening in Easton and Cambridge. For more information about these programs, contact Catalina Billings, Outreach Coordinator, 410-820-9400, [email protected]. 

In the United States, health concerns that land someone in the hospital or require multiple visits to the doctor can be a taxing experience on emotional, logistical and financial fronts.

But for about 17% of Marylanders facing medical debt, these struggles get compounded, leading to additional stressors that can further impact health outcomes, particularly for Black families and patients, according to economic policy organizations.

“[Medical debt] really does impact everyone on some level. It doesn’t impact folks equally,” according to Berneta Haynes, senior attorney for National Consumer Law Center. “It does have a disparate impact based on race and income.

Haynes participated in a webinar hosted by Economic Action Maryland this month, aiming to shine a light on how medical debt disproportionately impacts communities of color.

Economic Action Maryland conducted a poll in October 2020 surveying Marylanders, and found that 12% of survey participants had a medical debt they could not pay. In addition, 26% of participants stated that they would be unable to pay for an unexpected $500 medical bill out of pocket.

Marceline White, executive director of the organization, said that the average costs of a four-day hospital stay is about $14,200.

“It’s expensive to go to the hospital,” she said during the webinar.

White explained that when people have medical debt hanging over them, problems can compound and result in credit issues and even lead into other health concerns as patients delay medical care.

“We saw this particularly during the COVID pandemic. People did not go to hospitals to get treatment because they were afraid. They already had a medical bill they already medical debt,” she said.

Haynes, with the National Consumer Law Center, echoed White’s concern about people delaying hospital visits during an interview with Maryland Matters.

“People start making risky decisions related to their health,” Haynes said. “They start foregoing necessary health care visits that can then worsen whatever condition they may currently have — and snowball into more medical debt down the road.”

Which is a particular concern when it comes to the higher rate of Black families facing medical debt.

According to data from the Urban Institute, which tracks various forms of debt and how they impact Black communities, about 13% of communities of color in Maryland have medical debt, compared to 9% of white communities.

According to the most recent U.S. Census data from 2020, 48.7% percent of Marylanders are white and 29.5% are Black. About 21.9% of Marylanders are some other race or a mix of two races.

Another factor leading to medical debt can be whether a patient has insurance or not. Haynes explained that Black communities tend to have higher rates of various chronic illnesses but also may not have insurance, which can lead to medical debt

“Even in the states that have expanded Medicaid, like Maryland, we still see that Black folks are more likely to be uninsured, more likely to lack access to hospitals and health care providers nearby, so they have to go to providers that are out of network,” she said. “More likely to see higher maternal fatality rates. All kinds of cancers are highly concentrated in Black families. All of that makes Black people more likely to accrue medical debt than other groups.”

Both Haynes and White said Maryland’s efforts to reduce medical debt should be be a role model for other states.

The Medical Debt Protection Act, which took effect without being signed by former Gov. Larry Hogan (R) in 2021, issued a handful of protections for patients facing medical debt.

Under this law, hospitals are not permitted to request arrest warrants on patients if they are trying to collect medical debt.

“I don’t think it ever crosses people’s minds that a medical debt can lead to your arrest,” Haynes noted.

The 2021 law requires hospitals to check a patient’s eligibility for financial assistance before filing a lawsuit. In addition, hospitals are required to refund patients if they are deemed eligible for financial assistance within 240 days of billing.

“Maryland would be seen as one of the states that is doing the most,” White said. “But we still see, despite that effort, thousands and thousands of people falling through the cracks for a variety of reasons. And again, disproportionately affecting Black and Brown communities.”

Part of the issue to how patients get medical debt in the first place is the lack of knowledge that non-profit hospitals are required to provide financial assistance, also referred to as charity care, for low income people under the federal Affordable Care Act.

With charity care, hospitals may provide free or discounted services to eligible low-income patients who cannot afford services,

But hospitals may have different qualifications for who is considered “eligible” for financial assistance.

“That means from hospital to hospital, the threshold for when you qualify for financial assistance will differ. You may qualify for one hospital in the Baltimore area and not in another hospital in the Baltimore area,” according to Haynes.

For example, Lifebridge Health’s financial assistance policy says that it “provides hospice care at a discount to eligible patients of limited means whose household income is between 300% and 375% of the Federal Poverty Guidelines for the patient’s family size,” according to its website.

But Medstar’s financial assistance policy says that “partial financial assistance for medically necessary care provided to uninsured and underinsured patients with household income between 201% and 400% of the FPL.”

Haynes says that one of the most impactful way to address medical debt would be to set an income floor for all hospitals under the ACA. But she also urges lawmakers in Maryland and across the United States to consider policies that can specifically help with the inequity in medical debt that Black families and patients face.

“I think a little bit of both would be the right approach,” she said.

“But I think it’s also important for lawmakers to figure out how to prioritize relief for Black families…or at least be aware that the legislation that they are introducing may have a specific impact on Black families and Black folks,” she added.

By Danielle J. Brown

A year ago, a new three-digit phone line launched nationwide, making it easier for people facing a mental health crisis and other issues to find resources and support.

Since then, national data show that more people are reaching out to what’s called the 988 Suicide and Crisis Lifeline. Yet call counselors and call center managers in Maryland want more people to be aware of the line and how it can help.

The 988 Lifeline — previously called the National Suicide Prevention Lifeline — had been ten-digits long. But in 2020, a new federal law required the phone number to be changed to 988 and that it be designated as the national suicide and mental health crisis hotline.

Chris Niles, senior hotline counselor with the Baltimore Crisis Response, said that the three-digit number is easier to remember, especially when people are in crisis and may not be in the clearest mindset.

“When your house is on fire, you’re in a car accident, someone steals your purse, it’s real easy to remember ‘I call 911,’” Niles said. “But when you’re experiencing extreme depression or suicidal thoughts, grieving the loss of a loved one, memorizing an 800-number when you’re in that type of emotional distress is probably not the easiest thing.”

“So, when they established 988, they made it so much easier for people reach out and get the help that they need,” he said.

The 988 line has been active nationwide for a year as of July 16, and 26 states have passed laws and appropriated funds to support the line, according the National Academy for State Health Policy.

That includes Maryland. In the 2022 session, Gov. Larry Hogan (R) approved Senate Bill 241/House Bill 293, which established a fund for the program. In 2023, Gov. Wes Moore (D) approved Senate Bill 3/ House Bill 271, which carved out $12 million for the 988 fund in the 2025 budget.

In addition, the 988 line has a new LGBTQ+ pilot program that focuses on connecting that population to resources and counseling specific to their struggles.

The original number, 1-800-273-8255, “will always remain available to people in emotional distress or suicidal crisis,” according to the 988 Lifeline website.

In the year since the 988 line’s launch, Niles with the Baltimore Crisis Response has noticed an increase in callers who are looking for support while facing housing instability, as COVID-era federal support comes to an end even when many are still struggling to make ends meet.

Just last week, he spoke with an elderly woman who was recently evicted.

“Her story is pretty commonplace here. When the eviction restriction moratorium from the White House was lifted … she was one of many in Baltimore City that wasn’t able to pay. And the landlord ended up evicting once they were allowed to,” he said.

“And now she’s living, alternating between the street and a hotel. And so she was calling and asking for information on different shelter programs, different programs to help her get into an apartment and also local resources for food and whatnot,” he added.

Niles noted that people will call the 988 lines when they are in less dire situations as well.

Amid the COVID-19 pandemic, he noticed an increase in people calling to talk about their interpersonal relationships, with family members or with partners, as the pandemic led people to spend more time at home.

He also noted that some people will call if they have stress at work.

“They’ll ask ‘Is it okay that I’m calling? I’m not suicidal – I just had a really crap day at work and want someone to talk to.’ And we tell them ‘of course.’” Niles said.

Niles explained that the types of calls will determine what resources will be most helpful for the person in crisis. Many calls are just looking for information on resources that are available.

Others may need community intervention, he said, which is typically addressed by a mental health team sent out from a crisis center. Law enforcement is not usually involved unless it’s absolutely necessary.

According to national data from the federal Substance Abuse and Mental Health Services Administration, answered calls to the 988 line increased by 45% in May 2023 compared to May 2022, before the 988 Lifeline launched. Online chats for the crisis line saw an increase of 52% from May 2022 to May 2023.

But the largest percentage increase in people reaching out to the crisis line came in the form of text messages. From May 2022 through May 2023, the percentage of texts answered increased by 938%, according to SAMHSA data.

Dan Rabbit, policy director at Behavioral Health System Baltimore, which oversees the 988 and crisis services for the Central Maryland region, has seen similar increases locally.

“That explosion in text messages — not many people texted it before, so [it’s] starting from a lower number, but still — that little increase is astounding,” he said. “And that way of contacting 988 is more popular with younger people. So, it’s a sign that young people are hearing about this and are using our services to get the support they need.”

Rabbitt said that the 988 line has made a lot of progress in the year since it launched and he is excited to see how it will continue to “transform how Marylanders receive care for their mental health challenges.”

“988 counselors are here to help anyone, regardless of the intensity or the acuity of whatever is concerning them,” he said. “So there’s no wrong reason to call.”

By Danielle J. Brown