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5 years after Sandy Hook, mental health care worries linger

Anguished mothers with mentally ill children have sought out Liza Long for help ever since she wrote an essay, “I am Adam Lanza’s Mother,” comparing experiences with her son to the emotionally troubled 20-year-old who carried out the Sandy Hook Elementary School shooting.

The massacre sounded alarms nationally about gaps in mental health care and led to calls for better screening and services, especially for young people showing a propensity for violence, but some key reforms enacted in the wake of the Sandy Hook shooting depend on funding that has yet to be delivered by Congress. And Long still hears almost daily from families overwhelmed by their children’s behaviors and struggling to get treatment.

“We’re still not seeing the health access, the access to mental health care,” said Long, an Idaho mother of four and community college instructor who credited her essay with attracting the attention of a physician who correctly diagnosed and treated her then 13-year-old son for bipolar disorder.

Like other mass shootings before and since, the tragedy prompted calls for tighter controls on guns and improved mental health treatment, but five years later, mental health care providers are waiting for promised boosts in funding and many families are still battling insurance companies to cover their children’s services. While advocates say the quality of mental health care varies widely by state, they also see reason for optimism in a push for more early intervention programs and changing public attitudes about mental illness.

“There’s a lot of reason to feel optimistic,” said Ron Honberg, senior policy adviser at the National Alliance on Mental Illness. “But there are a lot of challenges too, particularly around financing these services.”

The 21st Century Cures Act, which was signed into law by then-President Barack Obama in December 2016, was inspired in part by the tragedy and included what proponents touted as the first major mental health reform package in nearly a decade. The measures that were included in the law but still await funding include grants for intensive early intervention for infants and young children showing signs of mental illness.

“There were a lot of things people took credit for passing,” said U.S. Rep. Elizabeth Esty, a Democrat whose district includes Newtown. “If they’re not funded, it’s a nice piece of paper and something hanging on somebody’s wall, but it’s not going to help save lives.”

Mental health experts point out the vast majority of people diagnosed with psychiatric disorders do not commit violent crimes, and no motive has ever been determined for the Dec. 14, 2012, massacre in which Lanza gunned down 20 children and six educators after fatally shooting his mother at home.

A report by the Connecticut Child Advocate noted that Lanza’s mother rejected recommendations that her son be medicated and get treatment for anxiety and other conditions, but it concluded his actions were not directly caused by his psychiatric problems.

Rather, it said, his “severe and deteriorating internalized mental health problems,” when combined with a preoccupation with violence and access to deadly weapons, “proved a recipe for mass murder.”

In her column, Long wrote that she was terrified of her son, who was prone to violent rages and had been placed in juvenile detention facilities four times. Only a few weeks earlier, her son had pulled out a knife and threatened to kill her. Since receiving treatment, her son, who is now 18, has not had another violent episode.

“People don’t understand the world that parents live in when they have a child with mental illness,” Long said. When other mothers reach out to her, she tries to match them up with resources in their states.

Many patients find the right treatment only after going through a lot of detours, said Dr. Vinod Srihari, director of the clinic for Specialized Treatment Early in Psychosis at the Connecticut Mental Health Center in New Haven.

“The nature of these illnesses is that they’re often misunderstood,” said Srihari, also an associate professor of psychiatry at the Yale School of Medicine. “And so, families with a young person with psychosis can often not rely on others around them to assist because what they’re struggling with is misunderstood and could be a source of shame and embarrassment. And that means that they can’t leverage their community supports to get the care they need.”

U.S. Sen. Chris Murphy, a Connecticut Democrat, said he expects it will be difficult to secure funding for the new programs in the Republican-controlled Congress. But, he said, there are other recent reforms that are also making a difference.

The creation of an assistant secretary position at the U.S. Department of Health and Human Services dedicated to improving behavioral health care has put pressure on insurance companies to cover the cost of mental health conditions equally as physical health, he said.

The 21st Century Cures Act also created a committee to advise Congress and federal agencies on the needs of adults and young people with serious mental illness. It is scheduled to meet Thursday, the fifth anniversary of the Sandy Hook massacre, to discuss the group’s first report to Congress.

Committee member John Snook, executive director of the Virginia-based Treatment Advocacy Center, said there is cautious optimism about improvements to come from the focus the Sandy Hook shooting put on mental health.

“We are definitely cognizant that the window is closing and attention is shifting,” Snook said. “You don’t want another tragedy to be the reason people are reminded they need to focus on these issues.”


Associated Press writer Robert Bumsted in New Haven, Connecticut, contributed to this report.

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Maryland health exchange extends deadline to enroll in Obamacare

Marylanders seeking health insurance under the federal Affordable Care Act will get an extra seven days to sign up, state officials plan to announce Wednesday.

The new enrollment deadline is December 22 rather than Friday.

The deadline was extended by a week to accommodate procrastinators and avoid a last-minute enrollment crush at the end of this week.

The state had adopted a shortened 45-day enrollment period set by the Trump administration for purchasing health insurance, known as Obamacare, on the federal exchange used by most states. But Maryland operates its own online marketplace for those who do not get insurance through their jobs and was free to extend the deadline.

Parents Worry Congress Won’t Fund The Children’s Health Insurance Program

Nine million U.S. children get their health coverage through CHIP, a program jointly funded by federal and state governments. Several states say they can't fund the program alone past January.

Nine million U.S. children get their health coverage through CHIP, a program jointly funded by federal and state governments. Several states say they can't fund the program alone past January.

It’s a beautiful morning in Pittsburgh, but Ariel Haughton is stressed out. She’s worried her young children’s health insurance coverage will soon lapse.

“So, we’re like a low-middle-class family, right?” she says. “I’m studying. My husband’s working, and our insurance right now is 12 percent of our income — just for my husband and I. And it’s not very good insurance either.”

States Sound Warning That Kids' Health Insurance Is At Risk

The policy that covers the couple requires high fees to even see a doctor, and has a high deductible for further treatment.

In contrast, her young children — 2-year-old Nonnie and his big sister Rose — are covered right now through the Children’s Health Insurance Program, or CHIP, a federal-state program that was created two decades ago to ensure that kids whose parents don’t have a lot of money, yet make too much money to qualify for Medicaid, can still get health care.

Right now, that coverage for the children doesn’t cost the family anything.

But Pennsylvania’s CHIP program is forecast to run out of money in February.

Though nine million kids across the U.S. get their health insurance through CHIP, Congress let the program expire on September 30.

Since then, states have been burning through the cash that remains in their CHIP accounts, and parents, doctors and state officials are wondering if Congress will save what has traditionally been a very popular program, with bipartisan support.

“CHIP is probably one of the most successful government programs we’ve enacted in the last couple of decades,” says Timothy McBride, a professor of health economics at Washington University in St. Louis and chairman of that state’s Medicaid oversight committee, which also oversees CHIP.

Keeping kids insured doesn’t cost much, he says, and it sure pays off.

It’s extremely important,” he says, “because it’s developmental — it’s vaccines. You know it can reduce the likelihood that a person has a lifelong chronic disease.”

The experience of Ariel Haughton’s daughter Rose bears that out.

Haughton says her own insurance policy charges $150 for each of her doctor visits, but her kids’ policy doesn’t. That allows her to take Rose and Nonnie for care when they need it.

“That’s not a small deal to a family like mine,” Haughton says. “A hundred and fifty dollars. If you have to pay that, you kind of ask yourself, like, ‘Are they sick enough? Does this merit a doctor visit?’ “

A few years ago her daughter Rose came down with a fever and a rash on her face. It didn’t seem severe, but Haughton took Rose to the pediatrician anyway, just to check.

“The doctor looked at her and she said, ‘She has Lyme disease,’ ” Haughton recalls. “And she found a little tick!”

The doctor put Rose on antibiotics immediately and the little girl’s symptoms went away. But if left untreated, Lyme can turn into chronic arthritis or other chronic problems.

“I know that if I had had to pay $150, I would have thought, ‘You know, let’s wait,’ ” Haughton says.

Dr. Todd Wolynn is the Haughton’s pediatrician. He says families all over Pittsburgh are worried about the lapse in the federal insurance program’s funding.

“Parents are literally telling us they don’t know what to do,” Wolynn says. “They make too much to get Medicaid and they don’t have jobs or earn enough to get the commercial insurance. I don’t know what to tell them to do.”

Doctors and patients around the country are worried as CHIP money runs out in one state after another.

Utah announced it will end CHIP at the end of January if Congress doesn’t come up with money for the program. West Virginia’s CHIP board voted to end the program February 28. And Colorado sent letters to its CHIP families saying that without new money the program will be cut off at the end of January.

Oregon has already run out of federal money, and is borrowing from its Medicaid budget to ensure its 80,000 CHIP kids keep their coverage through April.

“I’m absolutely opposed to kicking these vulnerable families off of access to health care,” says Oregon Gov. Kate Brown. “It’s appalling to me that Congress is not taking action and is not doing their jobs on this issue.”

Measures to fund the program passed in their relevant committees in the House and Senate in October, but then hit a snag when lawmakers couldn’t agree on other budget cuts to pay for CHIP.

Ariel Haughton says lawmakers should have gotten ahead of the problem.

“They could have worked on something in August or July, and passed it in September,” she says, “instead of just letting funding lapse and playing this game of chicken with our children’s health insurance.”

Lawmakers and staffers in Congress say CHIP funding will likely be included in an end-of-year spending bill. But as of now, there is no CHIP funding bill scheduled for consideration.

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Jimmy Kimmel holds his baby son, post-heart surgery, in emotional health-care monologue

Jimmy Kimmel was absent from his ABC late-night show last week while his 8-month-old son, Billy, recovered from his second heart surgery. Ever since Billy was born with a heart defect and required immediate surgery, Kimmel has become an outspoken advocate for universal health care, occasionally using his monologue to plead with (or deliver scathing criticisms of) members of Congress. “No parent should ever have to decide if they can afford to save their child’s life,” he said tearfully in May.

On Monday, Kimmel returned to the stage with his son in his arms. Billy, wearing a tiny sweater vest, stayed remarkably calm on camera as Kimmel choked up once more while talking about his son.

“I was out last week because this guy had heart surgery. But look, he’s fine, everybody,” Kimmel said, his voice quivering as the audience cheered. Kimmel thanked his celebrity guest hosts, such as Chris Pratt and Melissa McCarthy, for filling in while he was gone. He had trouble getting the words out.

“Daddy cries on TV, but Billy doesn’t,” Kimmel joked. “It’s unbelievable.”

Then Kimmel segued into an emotional monologue about CHIP, the Children’s Health Insurance Program, which expired in October. Here’s the transcript:

We also want to thank the very bright and talented doctors and nurses at Children’s Hospital who treated Billy, and not just Billy, many kids with so much caring and compassion. Children from every income level whose health is especially threatened right now because of something you’ve probably never heard of, it’s called CHIP.

CHIP is the Children’s Health Insurance Program. It covers around 9 million American kids whose parents make too much money to qualify for Medicaid but don’t have access to coverage, affordable coverage, through their jobs, which means it almost certainly covers children you know.

About one in eight children are covered only by CHIP, and it’s not controversial. It’s not a partisan thing. In fact, the last time funding for CHIP was authorized was in 2015. It passed with a vote of 392 to 337 in the House and 92 to 8 in the Senate. Overwhelmingly, Democrats and Republicans supported it. Until now.

Now CHIP has become a bargaining chip. It’s on the back burner while they work out their new tax plans, which means parents of children with cancer, diabetes and heart problems are about to get letters saying their coverage could be cut off next month. Merry Christmas, right?

So this happened because Congress, about 72 days ago, failed to approve funding for CHIP since the first time it was created two decades ago. This is literally a life-and-death program for American kids. It’s always had bipartisan support. But this year, they let the money for it expire while they work on getting tax cuts for their billionaire and millionaire donors.

And imagine getting that letter, literally not knowing how you will afford to save your child’s life. This is not a hypothetical. About 2 million CHIP kids have serious chronic conditions.

I don’t know about you, I’ve had enough of this. I don’t know what could be more disgusting than putting a tax cut that mostly goes to rich people ahead of the lives of children. Why hasn’t CHIP been funded already? If these were potato chips they were taking away from us, we would be marching on Washington with pitchforks and spears right now.

Kimmel urged his viewers to call their representatives and “tell them to take a break from tax funds for a minute and fully fund CHIP immediately.” After a reminder to everyone to sign up for Obamacare (“In spite of President Trump’s effort to sweep it under his rug, Obamacare is not dead, it’s very much alive”), Kimmel turned the attention back to Billy.

Billy Kimmel makes his late-night debut. (Still from YouTube)

“Billy is doing great, by the way. He has one more surgery,” Kimmel said. “And this is amazing: He had an operation a week ago. They say he’s probably on track to win at least a bronze medal in the Olympics in 2036.”

Although Kimmel will likely get criticism for bringing his son on the air, the late-night host had a response ready in September — when he eviscerated the Cassidy-Graham health-care bill — for people who say he’s “politicizing” his son’s health-care problems.

“I want you to know: I am politicizing my son’s health problems because I have to. My family has health insurance. We don’t have to worry about this,” Kimmel said at the time. “But other people do, so you can shove your disgusting comments where your doctor won’t be giving you a prostate exam once they take your health-care benefits away.”

Read more:

Jimmy Kimmel slams critics of his emotional health-care plea, calls out Newt Gingrich

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Read Jimmy Kimmel’s scathing response to Roy Moore after their ‘Twitter war’

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Native Americans Feel Invisible In US Health Care System

Anna Whiting Sorrell, a member of the Confederated Salish and Kootenai Tribes in northwest Montana, had hernia surgery a couple of years ago. The Indian Health Service picked up a part of the tab for the surgery but denied coverage for follow-up appointments.

Mike Albans for NPR

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Mike Albans for NPR

Anna Whiting Sorrell, a member of the Confederated Salish and Kootenai Tribes in northwest Montana, had hernia surgery a couple of years ago. The Indian Health Service picked up a part of the tab for the surgery but denied coverage for follow-up appointments.

Mike Albans for NPR

The life expectancy of Native Americans in some states is 20 years shorter than the national average.

There are many reasons why.

Among them, health programs for American Indians are chronically underfunded by Congress. And, about a quarter of Native Americans reported experiencing discrimination when going to a doctor or health clinic, according to findings of a poll by NPR, the Robert Wood Johnson Foundation and Harvard T.H. Chan School of Public Health.

Margaret Moss, a member of the Hidatsa tribe, has worked as a nurse for the Indian Health Service and in other systems. She now teaches nursing at the University of Buffalo.

She says she has seen racism toward Native Americans in health care facilities where she’s worked, and as a mom trying to get proper care for her son.

Once, when she was on a health policy fellowship with a U.S. Senate committee, Moss’ son had a broken arm improperly set at a non-IHS health facility in Washington, D.C.

She asked the physician about options to correct it, but he told her it was fine, she said. “Even when I, as an educated person using the right words was saying what needed to happen, [he] didn’t want to do anything for us even though we had a [health insurance] card.”

For Native Americans, Health Care Is A Long, Hard Road Away

Moss then reluctantly pulled out a business card with the Senate logo, she recalled, and was instantly transformed in the doctor’s eyes from “this American Indian woman with my obviously minority son” to someone he could not afford to dismiss.

“It wasn’t until the person … felt they could get in trouble for this … then the person did something,” said Moss. “I felt like it was racism. Not everybody has a card they can just whip out.”

She says she feels discrimination is more overt, “in areas where American Indians are known about,” like the Dakotas and parts of the American Southwest, but also exists in places without big tribal populations.

In the NPR poll, Native Americans who live in areas where they are in the majority reported experiencing prejudice at rates far higher than in areas where they constituted a minority.

In places where there are few American Indians, Moss says, “people don’t expect to see American Indians; they think they are from days gone by, and so you are misidentified. And that’s another form of discrimination.”

Health care systems outside the Indian Health Service generally see very few Native American patients, because it’s so hard for American Indians to access care in the private sector. A lot of that has to do with high poverty and uninsured rates among American Indians, who also often live in rural areas with few health care providers.

“The strikes against people trying to get care are huge: geographic, transportation, monetary,” Moss says.

A persistent myth inside and outside Indian Country is that Native Americans get free health care from the federal government.

“I hear that all the time,” says Moss, sighing.

Sorrell started exercising and going on walks after her experience with hernia surgery.

Mike Albans for NPR

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Mike Albans for NPR

Sorrell started exercising and going on walks after her experience with hernia surgery.

Mike Albans for NPR

The federal government promised to take care of Native Americans’ health when it signed the treaties in which tribes gave up almost all of their land.

“Unfortunately, they have not kept up their end of the bargain,” Moss says.

Congress has long failed to allocate enough money to meet Native American health needs. In 2016 it set the Indian Health Service budget at $4.8 billion. Spread across the US population of 3.7 million American Indians and Alaska Natives, that’s $1,297 per person. That compares to $6,973 per inmate in the federal prison system.

Moss says the IHS can be less an aid to people than another bureaucratic barrier. “It is highly complicated,” Moss says, “even if you took out the racism, perceived or real.”

The IHS isn’t insurance. It’s more like the Veterans Administration, running clinics and hospitals where its members can get care. But the IHS is far smaller than the VA.

Federal funding is also supposed to pay for care in the private sector that IHS hospitals can’t provide. But, quoting a sardonic joke familiar to many in Indian Country, Moss says it’s well known that “you’d better get sick by June, because there won’t be any more money, or it’s life and limb only, those are the things that would be authorized.”

Anna Whiting Sorrell, a member of the Confederated Salish and Kootenai Tribes in northwest Montana experienced that firsthand. The IHS picked up part of the tab for her hernia surgery at a hospital outside of the IHS a couple of years ago, but when it was time to schedule follow-up appointments, Sorrell was out of luck.

“It got denied. My follow-up got denied,” Sorrell says. “[The hospital] didn’t even ask if I was willing to pay,” she says, and that felt like discrimination. “They would assume that other non-Indians would pay for it themselves, why do we as Indian people not get to make those decisions ourselves?” Sorrell asks.

She felt like she was falling through a crack in the health care system at a particularly poignant time.

Anna and her husband, Gene Sorrell, outside their home in Evaro, Mont. Anna eventually received follow-up care for her surgery, but the process took years.

Mike Albans for NPR

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Mike Albans for NPR

Anna and her husband, Gene Sorrell, outside their home in Evaro, Mont. Anna eventually received follow-up care for her surgery, but the process took years.

Mike Albans for NPR

“I was 57 years old. My mom died at 57,” Sorrell says. In Montana, the life expectancy for Native American women is 62, that’s 20 years less than for non-Native American women. The life expectancy for Native American men in Montana is 56.

With help from her tribe, Sorrell eventually got her follow-up care, but her journey from diagnosis to actually getting surgery took years, and the University of Buffalo’s Margaret Moss says a lot of Native Americans just give up.

“That is the idea out there in Indian Country … , ‘I’m not even going to try, because it’s not going to happen.’ Or they hear so many stories of people who did try, and it didn’t happen,” Moss says.

That means a lot of American Indians simply put up with what she calls, “tolerated illness.

“They say they’re fine, but they’re not,” Moss says, and their health problems often progress until it’s too late for treatment to help.

Anna Whiting Sorrell, a health care administrator for her tribes, says she is optimistic that the Affordable Care Act will make a big difference for Native Americans. It gives lower-income people access to affordable insurance coverage outside the IHS. Many Natives Americans who weren’t eligible for Medicaid before the ACA now are, too.

Moss is more skeptical that the ACA will make a big difference, in part because of entrenched institutional discrimination toward Native Americans in healthcare.

“Until attitudes change,” Moss says, “we’re still going to be in a sad situation.”

Our ongoing series “You, Me and Them: Experiencing Discrimination in America” is based in part on a poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. We have previously released results for African-Americans, Latinos, Asian-Americans, whites and women.

You can follow Montana Public Radio’s Eric Whitney on Twitter: @MTPRND

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Toward Better Understanding of How Fathers Contribute to Their Offspring’s Health

What can I do to prevent this in the future?

If you are on a personal connection, like at home, you can run an anti-virus scan on your device to make sure it is not infected with malware.

If you are at an office or shared network, you can ask the network administrator to run a scan across the network looking for misconfigured or infected devices.

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Fenway Health CEO resigns over handling of harassment complaints

The chief executive of Fenway Community Health Center resigned Sunday, under pressure from the board of directors, employees, and donors over his handling of complaints that a prominent doctor had allegedly sexually harassed and bullied staff members there for years.

Dr. Stephen L. Boswell’s departure after 20 years as chief executive came two days after a Globe investigation published online Friday detailed allegations of harassment and bullying by Dr. Harvey J. Makadon.

Makadon, 70, allegedly sexually harassed at least three male employees at Fenway Health and bullied both male and female co-workers, according to current and former employees of the Boston-based medical institution, known for its pioneering care and advocacy for LGBT patients.

The first serious complaint against Makadon was filed in 2013, according to interviews with current and former employees and documents reviewed by the Globe. But it wasn’t until this spring that Makadon, who was director of education and training at the Fenway Institute, Fenway’s research arm, was forced to resign.

Boswell in 2015 allegedly ignored an outside law firm’s explicit recommendation to fire Makadon, the Globe reported Friday. Boswell also failed to inform the board of the Makadon allegations, including those resulting in a $75,000 settlement last year with a former male employee, according to three employees and an internal document compiled by some employees to summarize events related to Makadon. The board learned of the issues in January 2017, after another executive took the information to the chairman, the sources said.

In a statement Sunday afternoon, the board’s executive committee announced Boswell was no longer employed by the organization.

The committee appointed M. Jane Powers, Fenway’s director of behavioral health and the only woman in senior management, as interim chief, while a search is conducted for a permanent replacement.

“Fenway exists to enhance the well-being of the lesbian, gay, bisexual, and transgender community, and all people in our neighborhoods and beyond,’’ the board statement said. “Fenway Health is bigger than any single person.”

The ouster was a dramatic turnabout from Friday, when Fenway’s chairman, Robert H. Hale, had issued a statement in response to Globe questions, saying the board was continuing to back Boswell, despite concerns about his handling of the Makadon situation.

Boswell, now 61, joined Fenway in 1994 and served as medical director. He became chief executive in 1997 and is credited with helping build Fenway into an institution with a $100 million budget that employs about 500 people and serves 29,500 patients annually.

In a statement Sunday evening, Boswell said he ordered “significant discipline” for Makadon when “unacceptable conduct” came to his attention.

“In retrospect, I would have done this differently. At the time, I earnestly believed that the steps taken would ensure the safety of my valued staff,’’ he said. “I profoundly regret that these actions fell short.”

The Fenway board approved a new contract for Boswell in late spring, just months after learning about the Makadon allegations. Boswell had total compensation of $456,158 in fiscal 2015, the latest tax filing accessible in GuideStar, a website that compiles nonprofit financial data.

Makadon’s alleged unwelcome touching of some male co-workers was widely known, according to three female former employees who witnessed it or were told of the behavior by alleged victims. It also was well known that Makadon, a prominent advocate for LGBT health care and a former chairman of the Fenway board, at times yelled at and belittled both male and female staff members, current and former employees said.

Makadon, in phone interviews, denied he sexually harassed co-workers and said Fenway executives did not present to him the allegations being brought to light in this report.

“Any allegation that my behavior at Fenway was sexually abusive in any way is completely untrue,’’ Makadon said in a statement.

Interviews and documents reviewed by the Globe detailed behavior by Makadon from 2013 through 2016 that allegedly involved uninvited touching of at least three Fenway employees — unwanted shoulder and neck rubs, a hand on a knee, hovering too close at a work station, and in the worst case, allegedly putting his hand into the back of someone’s pants. Employees also reported persistent dinner invitations and, in some instances, unwanted touching at off-site events.

In three sexual harassment cases where formal complaints were made, male employees reported being made to feel uncomfortable while alone in Makadon’s office with the door shut. One man started keeping a chair between himself and Makadon to prevent unwanted touching at his cubicle, according to a lawyer’s letter reviewed by the Globe and interviews with former Fenway co-workers.

Some employees who complained about Makadon’s behavior were advised to toughen up, according to the sources, and were told it was just “Harvey being Harvey.”

One of the alleged victims still works for Fenway. He said Makadon once asked if he could kiss him. Another time, he said, Makadon allegedly got close to him in an elevator, put an arm around his back, and then slid his hand down the back of the man’s pants.

The stories of two of the alleged victims who filed complaints — the one who settled and the man allegedly assaulted in the elevator — were corroborated by people close to them who heard the accounts firsthand shortly after they occurred. The third was confirmed by a Fenway employee with knowledge of the events.

Makadon denied the elevator incident and also said he had never tried to kiss anyone. He said Fenway has a culture where people sometimes hug or have casual contact and that his behavior was not outside the norm.

“I was never, ever told anything about people’s discomfort,” Makadon said. “The one thing that I feel terrible about is that I didn’t know about it, and nobody told me about it so I could change the behavior.”

Almost worse than Makadon’s alleged behavior, current and former employees said, was Fenway’s failure to stop it — particularly at an institution whose mission has long been to protect and advocate for a population that has faced oppression and violence.

Fenway’s chairman, Hale, said executives did speak about the allegations with Makadon. He also said that once the board learned of the behavior, it “took prompt and appropriate action to address the matter.” He added that Makadon was involved in research and did not treat patients at Fenway.

The alleged victims and witnesses coming forward about Makadon, and Fenway’s handling of the complaints against him, have been emboldened by the wave of sexual harassment cases sweeping the nation.

The Fenway employees who spoke to the Globe asked not to be identified, for fear of retaliation and losing their jobs. Former employees asked for anonymity because of the sensitivity of the subject.

Makadon did not deny he could be hard to work with. He acknowledged that, after the bullying complaints, Fenway required him to undergo a series of executive coaching sessions.

“I always knew there were people who felt like I was difficult,’’ he said. Although admitting to a combative work relationship with one alleged victim, he denied sexually harassing the man.

Makadon, a Columbia University-educated physician, was affiliated with Boston’s Beth Israel Deaconess Medical Center for most of his career and has been a member of the Harvard Medical School faculty since 1980. He was director of education and training at the Fenway Institute,
where he wrote a textbook and built a niche speaking with medical practitioners around the country on treating LGBT patients.

But in February 2013, a sexual harassment complaint was filed against Makadon with Fenway’s human resources department, according to employees and the summary document. That triggered an investigation by the Boston law firm Seyfarth Shaw, which resulted in sexual harassment training across the nonprofit and individual training for Makadon, according to the sources.

By July 2015, Fenway had adopted a “zero tolerance” policy on harassment, bullying, and violence in the workplace, according to the sources. That same month, the employee reported the elevator incident, and another employee also lodged a complaint, according to the sources.

That spurred the nonprofit’s chief financial officer, Jeffrey Lieberman, to order a second investigation by Seyfarth Shaw, according to the sources. Both Lieberman and the legal investigation report advised chief executive Boswell to fire Makadon, the sources said. But Boswell said Makadon was “too important” to fire, according to employees and the summary document.

Instead, Makadon was placed on a month-long leave and required to get more sexual harassment training, according to the sources. The management team was not broadly informed of the investigation, the sources said, so managers were not alerted Makadon should have faced greater scrutiny.

As a result, Makadon’s alleged victims had to keep working with him; at least one had to continue meeting with him alone in his office, sources said.

In January 2017, after more complaints about Makadon, Lieberman asked for a meeting with Hale, the board chairman, according to employees and the summary record. Lieberman shared with him the Seyfarth Shaw investigations, the sources said, and urged Hale to fire Makadon.

In March 2017, Fenway changed Makadon’s status to consultant from employee, according to the sources, but in April, the chairman ordered that Makadon be let go for good. The rest of his consulting contract was canceled, according to two employees and the summary document.

In a departure e-mail to staff, Makadon said an “exhausting” work trip earlier this year had “reinforced my thoughts that it is time for me to retire from full-time leadership and work.”

After Makadon’s dismissal, the board hired the Boston law firm Mintz Levin to conduct a review, this time of Fenway’s workplace policies and the actions taken by management and the board in response to the Makadon complaints, according to Fenway’s statement.

Fenway said it revised its policies on harassment, discrimination, and bullying, and held mandatory senior management training.

After the Globe posted the allegations about Makadon on its website Friday, Hale and Boswell sent an e-mail to Fenway staff saying “if internal leadership’s actions sent an inadvertent message to the Fenway Health community that this behavior is tolerated, we offer our community not only an apology, but a pledge to do better.”

But a wave of dismay rose among staffers, donors, and some board members over the weekend, according to several people who work there or advise directors, spurring a flurry of emergency board phone calls. Some employees threatened a protest ahead of a planned board meeting Monday night, and a group of Fenway donors called the Young Leaders Council wrote a letter to the board expressing concern.

“Protecting sexual harassers and bullies is in direct contradiction to everything the Young Leaders Council and Fenway Health stands for,’’ the e-mail said.

Kay Lazar of the Globe staff contributed to this report. Beth Healy can be reached at Follow her on Twitter @HealyBeth. Sacha Pfeiffer can be reached at Follow her on Twitter @SachaPfeiffer.

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Scientist studies health problems of Arctic living – Fairbanks Daily News

FAIRBANKS — If one had any doubt that scientist Larry Duffy is a busy man, one need only look at his University of Alaska business card. On one side it reads: Larry Duffy, Director, Resilience and Adaptation Program, while the other side reads: Larry Duffy, Professor of Chemistry and Biochemistry. Spend some time talking with the man at his office in the West Ridge Research Building and you realize Duffy’s interests and work are so varied he could probably use several additional sets of two-sided cards.


An education in the Far North

A native of Brooklyn, New York, Duffy earned his bachelor’s in chemistry from Fordham University in 1969. America was in the middle of the Vietnam War at the time, but Duffy received a two year deferment to earn his masters’s degree. When given a choice of which university to go to, Duffy chose UAF even though “if you’re a New Yorker you want to go to the University of Miami, because that’s where all the girls are.”

“I went out and looked at the little board in front of the chemistry office and the first university it had listed was University of Alaska, so I said, ‘That sounds like a good idea,’” Duffy said. “Of course, I didn’t think I’d get it.”

Duffy not only earned his master’s in organic chemistry at UAF, he also met Gerrie Sheridan, the woman who would become his wife. Duffy was commissioned as a lieutenant in the United States Naval Reserves and shipped out two days after his wedding day. However, he got lucky and didn’t get sent to the “hot war” in Vietnam, but instead spent the next three years fighting the Cold War, “sailing in circles, chasing Russian submarines around the Mediterranean.”

Duffy chose to return to UAF after his service was over and earned his Ph.D. in biochemistry in 1977. After several years of research at Boston University, the Roche Institute of Molecular Biology, the University of Texas and Harvard Medical School, Duffy returned to UAF in 1987 as an Associate Professor in the Department of Chemistry. He was made department head in 1984 and appointed the College of Natural Science and Mathematics Associate Dean for Graduate Programs and Outreach in 2000.

Duffy said he and Gerrie, a local real estate agent, came back to Alaska because it’s “a great place to raise kids and to have a family.” The couple have three children: Anne, an artist who teaches art at UAF’s College of Liberal Arts; Kevin, a computer expert who teaches in Portland; and Ryan, an engineer who recently graduated from UAF. 


Understanding the challenges of the Arctic

Throughout his career, Duffy has studied a variety of problems specific to life in the Arctic. While in graduate school, he studied the effects of seasons on large mammals with wildlife scientist Bob White, researching the “two key stresses” of temperature and light cycles that influence the sleeping and eating behaviors of Arctic people. Working with the US Army, they explored the role that melatonin “the hormone of darkness,” plays in these stresses, and discovered soldiers — and indeed all Alaskans — have increased melatonin levels in winter. This increase causes shifts in a person’s diurnal rhythm and is associated with seasonal affective disorder, which can influence activity and susceptibility to disease.

Duffy’s postdoctoral work focused on human proteins synthesis and bacterial toxins in human diseases. He studied beta amyloid and neurofibrillary tangles in Alzheimer’s disease. Duffy learned and used several biomarker assays, which he used in collaboration with UAF biologists and state and federal agencies to study species threatened by the Exxon Valdez oil spill. Duffy credits this work with putting him on the path to expanding his research. 

“I’ve broadened my research activity from protein structure into the area of wildlife and human environmental health. The oil spill focused my attention on the need to develop biomarkers to monitor and assess the health of wildlife populations. These studies demonstrated that chronic exposure could be measured biochemically in mammals, not only showing damage to a resource, but also demonstrating recovery of the ecosystem,” Duffy said.

“Biomarkers in human health research led my research group back to wildlife and fish, but this time I focused on mercury exposure to humans from the fish that Alaskans consume. My work on mercury in subsistence food has been used by policymakers on the national level and allows me to involve undergraduate students in research and discuss issues of environmental ethics and justice.”


Making education accessible

Duffy’s work as an educator is focused on mentoring graduate students, teaching junior and senior level biology and chemistry and teaching a slightly lower level of those subjects to allied health majors pursuing careers as nurses, dental hygienists, village health aides and lab technicians, among others. 

“It’s targeted toward their literacy associated with their profession,” he said. 

He is working on making the allied health courses available online for distance learning.

“It’s all about access. This allows students to stay in their community, where they have jobs and they’re working. And they can get these lower level requirements out of the way. If you’re living out in the village and have a family, you can’t move into Anchorage or Fairbanks, but a lot of jobs require you have a certificate. This is a global and national problem: We make  these requirements and then we don’t provide means and access,” Duffy said. 

Duffy said his department put one class online several years ago and it has been “extremely successful.” They plan to add more classes, one of which he will teach.


Exciting new research

Although he’s busy with the allied health program, Duffy continues his research. He continues to work on resilience and adaptation in environmental health and is eagerly anticipating a new project using sled dogs to study Alzheimer’s disease. Since “animals don’t know how to speak and take psychological tests,” Duffy will work with Dr. Kriya Dunlap to study the accumulation of beta amyloid, tau and other proteins associated with Alzheimers by measuring the amounts in the dogs’ brains via periodic MRI scans. The dogs will be sedated and a vet technician will be on hand to monitor the dogs during the scans. The participating dogs will be scanned from the ages of 3 or 4 to the time of their natural deaths, at which time a necropsy can be performed and the brain tissue examined. 

“Using noninvasive brain image scanning technology, we can begin to study interventions, such as diet and exercise, on the increase of beta amyloid and tau over time,” Duffy said. “I expect continued progress and support in understanding healthy aging in the Far North over the years.”

Contact staff writer Dorothy Chomicz at 459-7582. Follow her on Twitter: @FDNMcrime.

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School board members defends health insurance benefit – Fairbanks Daily News

FAIRBANKS — The Fairbanks region has only one local legislative entity offering health insurance to its elected officials — the school board.

Other local legislative bodies long ago eliminated health insurance compensation for their members, many of whom work day jobs and serve part-time in public office. However, the school board has maintained its health insurance benefit. 

Most members of the Fairbanks school board said they collect health insurance benefits from the school district in exchange for their public service. 

The cost to the Fairbanks North Star Borough School District to provide school board members with health benefits is $65,653 for the current fiscal year, according to the district’s chief financial officer. 

Other large school districts in Alaska also offer health insurance benefits to school board members. Members of school boards in Anchorage, the Matanuska-Susitna Borough and the Kenai Peninsula Borough are offered health benefits, according to officials with those districts. 

Juneau school board members do not receive health insurance, according to Kristin Bartlett, chief of staff at the Juneau School District.

Timi Tullis, director of board development and field services for the Association of Alaska School Boards, said board compensation is a local control decision and that it varies from district to district.

There was a time when health insurance was widely offered to local leaders in the Fairbanks North Star Borough. 

Members of the Fairbanks City Council did away with their health benefits in the late 1980s, according to City Councilman Jerry Cleworth, a long-time city leader. He said the council voted to eliminate council member health coverage as a cost-cutting measure.

Members of the Borough Assembly were allowed heath insurance as a benefit until a narrow vote in 2003 ended the practice, with proponents arguing that it is inappropriate to provide health insurance for part-time public service.

Members of the North Pole City Council also do not get health insurance from the city. Jeff Jacobson, former North Pole mayor and councilman, said in an email that he does not recall health insurance ever being offered to council members.

So why do Fairbanks school board members get health insurance? 

The News-Miner contacted school board members to ask why they should receive health care benefits. Their answers varied.

Tim Doran, a new member of the school board, said he declined the health insurance because he has other coverage but that he thinks it’s a valuable benefit that helps attract candidates to run for school board.

“It broadens the pool, especially people who might be more economically challenged,” he said. “You want a broad spectrum of people to run and be part of municipal government. There are some people who would find it very difficult to do for economic reasons.”

Board member Wendy Dominique said she accepted the health care benefit from the school district for herself and her husband but that her primary health care coverage is through her job on Fort Wainwright.

Dominique pointed out that compensation of local leaders varies from institution to institution. The school board stipend of $400 a month is substantially less than the Borough Assembly stipend of $900 a month, she said. 

“We do just as many hours as they do,” she said. 

Heidi Haas, president of the school board, did not disclose whether she accepts the health care benefit. 

“I can’t speak to why the other bodies compensate their members differently but believe that each body has the right to make that decision, as is the same across the state,” Haas said in an email. “Some school boards in the state offer retirement and some pay nearly $40,000 a year for board service, so there doesn’t appear to be a standard.”

Sean Rice, another Fairbanks school board member, said he rarely uses the coverage provided by the district. He said he has other health insurance that is his primary coverage. 

“I just did a bunch of signing,” Rice said. “They didn’t give me the offer to decline.” 

Board member Thomas Bartels said he didn’t know that the school district offered health insurance to its board members until after he was elected. He accepted coverage for himself and his family, he said.

“This is something that has been a part of the policy since probably 30-35 years ago,” he said. “I don’t have an answer as to why … Every institution is allowed to make their own judgment as to what they feel and deem necessary.”

Allyson Lambert said she accepted health insurance coverage for herself and her family. She also did not know the history of how health insurance became a benefit for serving on the school board.

Board member Sharon McConnell could not be reached for comment.  

Contact staff writer Amanda Bohman at 459-7587. Follow her on Twitter: @FDNMborough.

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Funding at risk for children’s health insurance, clinics

  • FILE - In an April 25, 2017, file photo, Sen. Debbie Stabenow, D-Mich., speaks during a media availability on Capitol Hill in Washington. Stabenow and others are sounding the alarm over the expiration of federal funding that provides health insurance to 116,000 lower-income children in Michigan, saying cancellation notices may be sent to families as early as next month despite bipartisan support for continuing the program. Photo: Alex Brandon, AP / Copyright 2017 The Associated Press. All rights reserved.



LANSING, Mich. (AP) — U.S. Sen. Debbie Stabenow and others are sounding the alarm over the expiration of federal funding that provides health insurance to 116,000 lower-income children in Michigan, saying cancellation notices may be sent to families as early as next month despite bipartisan support for continuing the program.

The Children’s Health Insurance Program was not reauthorized by the Republican-led Congress in September, and lawmakers are at odds over how to pay for a five-year extension. CHIP funds programs such as MIChild, which provides health and dental coverage for children from working families that make more than double the federal poverty level — $43,290 for a family of three.

And in the wake of Flint’s water crisis, Michigan also is allowed to spend some of the federal money to remove lead hazards from the homes of low-income residents in Flint and other communities.

Stabenow, a Democrat, said there will be “very serious” consequences if Congress does not extend funding for CHIP and community health centers that serve the poor and uninsured.

“This is unacceptable. This is something that is bipartisan, strongly bipartisan,” she told The Associated Press in a phone interview.

On Friday, President Donald Trump signed a two-week spending bill to prevent — for now — a government shutdown, which also makes money available to several states that are in danger of running out of CHIP funds this month. Michigan’s allotment has been expected to last until April or May, said state spokeswoman Angela Minicuci. But cancellation notices must be sent 90 days in advance in case the funds are not replenished.

More imminent are funding cuts to the community health centers, which are located at more than 260 underserved urban and rural sites across the state and served more than 680,000 people last year. They will lose 70 percent of their funding starting next month, with more exhausting their federal funds each month through June.

Centers whose grant cycles begin in January — and are at risk first — include Advantage Health Centers in Detroit, Bay Mills Health Center in the eastern Upper Peninsula, Community Health Social Services Center in Detroit, Covenant Community Care in Detroit, MidMichigan Community Health Services in the northern Lower Peninsula and Western Wayne Family Health Centers outside Detroit.

Among those in the Michigan delegation pushing to renew the funding is Republican Rep. Tim Walberg of Tipton. He said last month that CHIP is a “successful federal-state partnership” and called the health centers a “key component of the health care safety net.”

Legislation won approval in the House in November, and a Senate committee that Stabenow sits on OK’d a funding bill in October. But the popular programs have been caught up in talks over several end-of-year agenda items, including the budget, hurricane aid and protections for immigrants brought to the country illegally as children.

Families in MIChild pay a $10 monthly premium for coverage, and there are no co-pays.

“It literally is saving lives of children in Michigan,” Stabenow said.

The insurance, she said, lets parents who make too much to qualify for Medicaid take their kids to a doctor, avoiding expensive and potentially unnecessary trips to the emergency room.

The Flint Water Interagency Coordinating Committee, which Republican Gov. Rick Snyder created to help address the Flint crisis, is expected to soon send a letter to Congress warning that lead pipe replacement funding will be compromised if CHIP is not extended.

If the funding is not reauthorized, the state may try to keep MIChild and other programs going with additional state money.

“We need to discuss that with the Legislature to see if the funding would be available,” Minicuci said.


Follow David Eggert on Twitter at . His work can be found at

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