The number of foreign-born cases of active tuberculosis (TB) spiked 20 percent in Nevada in 2015, up to 60 from 50 in 2014.
It is not currently known how many of these foreign-born resident of Nevada diagnosed with active TB arrived in the state through the federal refugee resettlement program because Catholic Charities of Southern Nevada (CCSN), the resettlement agency hired by the federal government to manage the resettlement of refugees in Nevada, is concealing that data.
Nevada is one of thirteen states that have withdrawn from the federal refugee resettlement program. In those states, the federal government has selected a voluntary agency to resettle refugees under the statutorily questionable Wilson Fish alternative program. In Nevada, the federal government selected CCSN.
The Refugee Act of 1980 requires CCSN to conduct initial domestic medical screenings of arriving refugees, test them for active TB and latent TB infection (LTBI), report that data to the local county health department, and monitor their subsequent treatment for both conditions when diagnosed.
CCSN has not responded to several requests for this refugee health data from Breitbart News.
In 2015, Nevada reported 85 cases of active TB, according to the CDC, a 14.9 percent increase from the 74 cases reported in 2014.
In 2015, the percentage of foreign-born cases of active TB in Nevada increased to 70.6 percent, or 60 out of 85, according to Nevada 2015 TB Fast Facts, published by the Tuberculosis Prevention and Control Program of the Nevada Division of Public and Behavioral Health. Sixty-seven percent of Nevada’s active TB cases in 2014, or 50 out of 74, were foreign-born.
The 60 cases of active TB diagnosed among foreign-born residents of Nevada in 2015 broke down as follows, by country of origin: Philippines (20), Mexico (13), Ethiopia (5), China (5), Vietnam (4), India (5), Other/Unknown (8).
The 13 cases of active TB diagnosed in 2015 in Nevada residents whose country of origin were either Ethiopa or “Other/Unknown” likely arrived in the United States under the federal refugee resettlement program, but Catholic Charities of Southern Nevada, which has this data, has not responded to any of multiple requests for comment on this issue from Breitbart News.
As Breitbart News reported previously, the number of refugees resettled in Nevada has increased every year since FY 2011.
A number of the 3,339 refugees who resettled in Nevada between FY 2011 and FY 2017-to-date arrived from high TB burden countries, such as the Democratic Republic of Congo (530), Somalia (333) Eritrea (332), Burma (226), Bhutan (12), and Ethiopia (84).
During the entire five year period between FY 2011 and FY 2015, 430 cases of active TB were diagnosed in Nevada. 146 were U.S.-born, and 284 were foreign-born. Of the 284 foreign-born cases, 20 cases were diagnosed among Nevada residents who were born in Ethiopia, and 58 cases were diagnosed among Nevada residents who were born in “Other/Another” country.
The majority of these 58 foreign-born cases of active TB of Nevada residents born in Ethiopia or “Other/Another” country likely arrived in the United States under the federal refugee resettlement program.
When and if Catholic Charities of Southern Nevada confirms or denies this data, the number of refugees diagnosed with active TB in Nevada will be added to the 304 known cases of active TB diagnosed among refugees in fifteen states over the past six years.
Foreign-born cases of TB in Nevada have been a higher percentage of all cases diagnosed in the state than the national average in each of the past five years. The national percentage of foreign-born TB cases has gone from 62 percent in 2011 to 66 percent in 2015, while the Nevada percentage of foreign-born TB cases has gone from 74 percent in 2011 to 76 percent in 2012 to 70 percent in 2015.
(Sources: Centers for Disease Control, Nevada 2015 TB Fast Facts)
In 2012 the Nevada Policy Research Institute reported that CCSN has contracted with Southern Nevada Health District (SNHD), which is the county health department for Clark County (Las Vegas), to perform the initial medical screenings for the refugees they bring to Nevada. According to the report, SNHD did not conform to federal standards in its conduct of those initial medical screenings:
ORR [Office of Refugee Resettlement] guidelines state that the refugee medical “screenings should be performed by a qualified licensed health care professional.” And by such a professional, ORR means — as demonstrated through ORR’s use of federal billing codes — either a physician, a physician’s assistant, or a nurse practitioner.
SNHD’s contracts with Catholic Charities, however, only state that the district will have “a Community Health Nurse” do “a complete history and physical” on refugees.
All of the district’s community health nurses are registered nurses (RNs), according to the Nevada State Board of Nursing, and none are nurse practitioners (NPs), also called, in Nevada, advanced nursing practitioners (ANPs).
The health district’s use of RNs for such work would also appear to violate the Nevada Administrative Code’s regulations governing nurse practice.
“Well, it’s always been our understanding that we are in compliance with any medical screening guidelines, in terms of having community nurses conduct the screenings,” Carisa Lopez Ramirez, CCSN’s vice president for immigration and migration services, told the Nevada Journal at the time.
“It is our understanding that what [the RNs] are performing, is basically asking questions related to medical history. But in terms of the actual physical examination, [the RN] is being monitored by a medical director that oversees that whole program,” Ramirez added.
Breitbart News contacted SNHD to obtain refugee health data on LTBI rates and active TB cases discovered in the domestic medical screenings it conducts of refugees.
“The Southern Nevada Health District can only provide limited information regarding your request as we do not have all the data you are seeking regarding refugee health assessments; we do not see all refugees who come to the Las Vegas Valley. It is recommended that you contact Catholic Charities for information about refugees and asylum seekers. In addition, the Southern Nevada Health District would not have information related to the State of Nevada as a whole. It is recommended that you contact the state’s Division of Public and Behavioral Health for statewide information. The Health District also would not have information specifically related to parolees,” a spokesperson tells Breitbart News.
A spokesperson for SNHD provided refugee latent TB infection rate information “based on clients seen at the Southern Nevada Health District. ”
“Domestic medical screenings can be provided by the Southern Nevada Health District as well as other healthcare providers in the community,” the spokesperson said.
Of 3,184 refugee clients “seen at the Southern Nevada Health District” between 2011 and August 2016, 547, or 17.3 percent, tested positive for LTBI.
That rate was higher for the eight month period between January and August 2016: 108 out of 436 refugees, or 24.6 percent, tested positive for LTBI.
Significantly, SNHD does not track treatment rates for refugees who test positive for LTBI.
“The Southern Nevada Health District does not have information related to the number of LTBI refugees who have completed treatment as well as those with active disease. The State of Nevada reports TB cases as ‘foreign born’ which includes refugees, as well as US citizens. You will need to contact the State of Nevada for additional information,” a spokesperson tells Breitbart News.
Under the Refugee Act of 1980, CCSN has the responsibility to monitor the treatment of refugees who test positive for LTBI.
Whether the organization is treating refugees who test positive for LTBI was one of several questions Breitbart posed repeatedly to CCSN to which it received no response. The other significant question that CCSN has yet to answer is how many of the refugees it has helped resettle in Nevada have been diagnosed with active TB.
The federal Office of Refugee Resettlement website lists Carisa Lopez Ramirez of CCSN as both the State Refugee Coordinator and State Health Coordinator. Ms. Ramirez’s voice mail at CCSN indicates she is Vice President of Immigration Services there.
The Nevada Division of Public and Behavioral Health (NDPBH) was able to provide very little of the refugee health data requested by Breitbart News.
A spokesperson for the Tuberculosis Prevention and Control Program of Nevada’s Office of Public Health Informatics and Epidemiology, which is part of NDPBH, told Breitbart News in an emailed statement:
Unfortunately, the TB Program for the State of Nevada only collects information for active TB cases for the time period you are requesting-we do not collect data on LTBI cases for any case before 2016.
I tried to pull a report on the Domestic Screening information out of a different CDC database the State has access to, but I do not have access to those reports as well as I am not able to differentiate between immigrant and refugee (the two populations are combined together). Also, I was not able to look up the records one-by-one as I originally thought we could do, as several cases each year had incomplete information. (For example, some cases did not have the completion data or the treatment start date etc.) So I will not be able to attempt to answer the domestic screening questions you have listed as it would be very incomplete.
You will need to contact Catholic Charities of Southern Nevada regarding all of the domestic screening questions . . . I am not sure who the domestic screening program/medical provider was for this five year period. You will want to contact Carisa Lopez-Ramirez at Catholic Charities for most of your questions. If she does not have the data available, perhaps you can get it from the domestic screening program/medical provider directly.
The spokesperson added that ” [the] [t]otal number of B1, B2, B3 TB notifications received by Nevada (for both refugees and immigrants) from 2011-2015 was 2,216. (Total number of refugees who arrived with a B1, B2 or B3 TB notification 105 during 2011-2015).”
Breitbart News will continue to question CCSN until it receives answers to the important refugee health data questions it has posed repeatedly, without response so far.
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