State of Michigan Hides Refugee Health Data

The state of Michigan is refusing to release refugee health data to the public unless a Freedom of Information Act request is filed.

Breitbart News has filed a such a request and is asking for refugee health data for the five year period from 2011 to 2015 that includes the percentage of arriving refugees who successfully complete their initial domestic medical screening, number who arrive with active tuberculosis (TB) or are diagnosed with the disease within five years of arrival, and the percentage who test positive for latent TB infection (LTBI) upon arrival. That data has not yet been provided.

As Breitbart News reported previously, the federal government has increased the number of refugees resettled in Michigan year-to-date in Fiscal Year 2016 by 43 percent.

Michigan has received 1,115 of the 10,700 Syrian refugees resettled in the United States during the first eleven months of Fiscal Year 2016, by far the greatest per capita Syrian refugee settlement rate of any state.

One county in Michigan alone, Oakland County, with 360 Syrian refugees resettled, has received a greater number of Syrian refugees this fiscal year than forty other states during these eleven months.

Seven other states, including California, Texas, Indiana, Utah, Arizona, Minnesota, and Florida, readily make most of this refugee health data public in reports that are published annually.

Sharing such important public health data is consistent with more than a century of federal and state laws that promote transparent and open government when it comes to reporting on the incidence of diseases that can impact public health.

It is also consistent with the requirements of the Refugee Act of 1980, which established the federal refugee resettlement program, and existing public health laws in most states.

Michigan now joins a number of other states, including New York, Massachusetts, and Kentucky, which are not complying with these standards.

Some states, like Louisiana, Nebraska, Wisconsin, and Colorado, made this data available to Breitbart News without requiring the submission of a Freedom of Information Act request, even though they do not publish annual reports on refugee health.

Some states which do not publish annual reports on refugee health, like Tennessee, have ultimately provided partial information on latent TB infection rates, but continue to refuse to provide active TB data

One other state, Idaho, provided partial data on latent TB infection rates and refugees who had active TB upon arrival, but asked Breitbart to file a Freedom of Information Act request to obtain more detailed statewide data on the number of refugees diagnosed with active TB within five years of arrival and with county level breakdowns of all refugee health data.

The state of Michigan’s response to Breitbart News began well enough.

“I’m responding to the questions you sent to Al Horn in our Office of Refugees Services,”  Bob Wheaton, director of communications for the Michigan Department of Health and Human Services, told Breitbart News last week.

“Michigan requires doctors, clinics and health departments that have contracts for providing medical screenings to include a test for LTB1. However, an individual can’t be forced to undergo a medical screening. Almost all refugees do undergo medical screenings because they want to identify any health problems,” Wheaton said.

“Ingham County Health Department, Kent County Health Department, Calhoun County Health Department, a private doctor in Wayne/Oakland/Macomb counties (one in each county), and St Joseph Hospital in Washtenaw County provide the screenings,” he continued, promising to look into the additional information requirements over the next few days.

Wheaton’s subsequent response, however, was not to immediately provide Breitbart News with the requested information:

Due to the extensive amount of information you’re requesting and the resources that would need to be devoted to collecting and providing the information, we’re asking that you submit a request under the Freedom of Information Act. . .You will hear back from our FOIA office within the 5 business days required in the law.

Here is the information the state of Michigan does not make readily available to the public which the state says requires a FOIA request:

Percentage of refugees who complete domestic testing within 90 days

Percentage of refugees who test positive for latent TB infection

Number of refugees diagnosed with active TB during initial domestic medical screening.

Number of refugees diagnosed with active TB within 5 years of arrival.

Among the seven states that comply more substantively with refugee public health reporting standards, a number of them actively explain their obligation to transparently provide this information.

The Texas Refugee Health Program (RHP), the state of Texas agency that “provide[s] eligible clients with culturally and linguistically appropriate comprehensive health assessments, including follow-up and referrals for health conditions identified in the assessment process”  makes it clear that it regularly publishes this refugee health data because it “is contracted by the Texas Health and Human Services Commission’s Office of Immigration and Refugee Affairs [the state agency in charge of implementing the federal Refugee Act of 1980] to provide these services.”

The Texas RHP understands and complies with its statutory reporting obligations:

Refugee health clinics are required to submit a health assessment form for every newly arrived client within their jurisdiction. The RHP has implemented a statewide web-based data system to ensure consistently high and timely rates of quality health assessments for all eligible clients. Analysis of submitted health outcome data allows for enhanced contract monitoring of clinic programs throughout the state, as well as improved surveillance of specific diseases and conditions. The RHP produces and distributes summaries of refugee health data throughout the refugee resettlement community

In the State of Indiana Refugee Health Program Annual Report for FY 2015, the Refugee Health Program at the Indiana State Department of Health (ISDH) states it “is responsible for providing oversight and coordination of health services to refugees in Indiana.” The mission of the RHP “is to support the resettlement of refugees by providing access and resources for an initial health screening upon arrival to the United States, by identifying emerging health issues in refugee populations and to provide ongoing support through relationships with community, state and federal partners.”

Minnesota has provided extensive public health data about arriving refugees annually since 2004, including latent TB infection rates (34 percent in 2004), Hepatitis B infection rates (9 percent in 2004), parasitic infection rates (17 percent in 2004), sexually transmitted infections, and malaria infections.

Minnesota also provided key information about infection rates by country of origin. In 2004, for instance, the latent TB infection rate among refugees arriving from Sub-Saharan African countries was 55 percent. (In 2014, overall latent TB infection rates for arriving refugees in Minnesota was 22 percent. For those arriving from Sub-Saharan African countries it was 30 percent.)

Michigan is not the only state that attempts to conceal refugee health data. As Breitbart News reported in June:

Most of the 49 states in which the federal government resettles refugees . . . fail to report either LTBI rates among all resettled refugees or the percentage of those who test positive for LTBI who successfully complete treatment, despite the requirements of the Refugee Act of 1980 that all such medical results be reported to the county public health departments in each county where refugees are resettled.

States like Michigan which either conceal or make it difficult to obtain refugee health data advance the argument that the public does not have a right to know this information, and further maintain that the Refugee Act of 1980 does not specifically require them to publicly report this data.

But as Breitbart reported previously, refugee resettlement agencies are required by the Refugee Act of 1980 to assure “that refugees, known to the agency as having been identified . . . as having medical conditions affecting the public health and requiring treatment [such as active and latent TB], report to the appropriate county or other health agency,” and that their health status is subsequently monitored by both the county or other health agencies.

When county, state, or other health agencies have this data which can have an impact on public health in their possession but conceal it from the public, the most common justification provided by the governmental entities and resettlement agencies is that providing data on the entire refugee population in a specific area would be a violation of HIPAA laws and regulations that govern individual health privacy.