Frederica Freyberg:

I’m Frederica Freyberg. Tonight on “Here & Now,” the health risks of vaping from a Milwaukee doctor who helped pinpoint the threat and a closer look at the politics of school test scores. Connecting the dots between investment and results. It’s “Here & Now” for September 20.

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Funding for “Here & Now” is provided in part by Friends of Wisconsin Public Television.

Frederica Freyberg:

This week the U.S. Centers for Disease Control activated its emergency operations center to address the outbreak of severe and potentially deadly lung disease caused by vaping. U.S. Senator Tammy Baldwin called for the activation saying, “My home state has been on the front lines of this outbreak.” According to latest numbers from the Wisconsin Department of Health Services, our state has seen 48 cases of lung disease in 21 counties. Another 13 cases are suspected. No deaths have been reported in Wisconsin. Patients in the majority of cases according to state officials reported using e-cigarettes or vaping devices to inhale THC products like waxes or oils. Nationwide, there have been at least eight deaths confirmed with some 530 people suffering damaged lungs as a result of vaping. Now the Food and Drug Administration has reportedly launched a criminal investigation focusing on the supply chain of vaping products. With many people injured saying they have used black-market THC products. Meanwhile, two Kenosha brothers were criminally charged this week in connection with manufacture of THC vaping cartridges. Authorities describing the operation as a very large criminal enterprise. The prosecutor in the case says the cartridges found in the brothers’ home are being tested to see if they can be linked to any cases of lung disease. Against this rapidly developing public health crisis, doctors at Children’s Hospital of Wisconsin were among the first to connect the deadly lung disease to vaping. According to the governor, put Wisconsin on the national forefront of the investigation. We learn more now on this from the medical director of the Pediatric Intensive Care unit at Children’s, Dr. Michael Meyer who joins us now from Milwaukee. Thank you for being here.

Michael Meyer:

Thank you for allowing me to be here.

Frederica Freyberg:

Have you ever seen anything like the damage you’re seeing in people’s lungs from this outbreak linked to vaping?

Michael Meyer:

As part of being a pediatric intensive care physician, we see many cases of severely damaged lungs. What was interesting about this, was that it was in teenagers, the time of year and the fact that we had a cluster of teenagers that all came together in our hospital.

Frederica Freyberg:

What did the time of year have to do with it?

Michael Meyer:

Normally when we see what we call an interstitial pneumonitis and an interstitial pneumonia, we think wintertime. When we see it out of the season and we see it in teenagers, we start thinking bad diseases. And it involves a very extensive work-up of these children that involves a very large team of healthcare providers in order to sort through all of the questions and come up with a diagnosis.

Frederica Freyberg:

And so how kind of frightening was it for the team of physicians to see this cluster of this lung damage?

Michael Meyer:

You know, frightening I don’t think is the best word to describe it. I think that as a group and as a team, it became very intriguing and interesting. Every day that we’re here at Children’s, we’re here trying to do what is right and what is best for the healthcare of the children in our community. And you see a cluster and you go into your mindset of this is my one patient. This is how I’m going to take care of this patient. But in the back of our mind and throughout our training, we’re taught about public health and trying to associate clusters of disease presentations and think about the bigger picture. That’s really what happened here.

Frederica Freyberg:

Have you isolated what is causing the damage?

Michael Meyer:

No, here we haven’t. Our focus really has been on the clinical care of the children that have been here at Children’s and then utilizing our resources with Wisconsin Department of Health to really sort out what could be this. I view us as a canary and we were the first canary in order to put the pieces together because here at Children’s, we’re the referral area for the state. So seriously ill, seriously injured children show up at our doorstep from all over the state of Wisconsin.

Frederica Freyberg:

Specifically what happens to people afflicted, and how are physicians able to prevent them from dying?

Michael Meyer:

So I think we saw some common things as we went back through our cluster of children. Usually we saw a couple weeks of weight loss, decreased energy, increased work of breathing, and just overall difficulty with breathing. Then something changed in the children which led them to seek healthcare. With increasing work at breathing and all of them had low blood oxygen saturation and needed supplemental oxygen and large amounts of supplemental oxygen for some of them.

Frederica Freyberg:

Does it make a difference in the outcome for people to seek care sooner?

Michael Meyer:

I think that’s a great question that we’re still trying to sort out many of those pieces. That’s why understanding from a CDC standpoint, the total number of patients that are affected by this so that we can get a better understanding. There is always going to be unique characteristics of each individual patient that it may be a long time of exposure or short time of exposure and it’s going to be up to that individual patient’s response to, in this case, what we think is vaping.

Frederica Freyberg:

So of the patients in 21 counties, if they are pediatric cases, are they actually coming to your facility or are you working with their physicians?

Michael Meyer:

A little bit of both. Children’s here in Milwaukee, we are the referral point for the state of Wisconsin. We service the entire state of Wisconsin, northern Illinois and pieces of Michigan and Minnesota. We’re very proud of our tertiary-quaternary care center and being a center of expertise for the care of children. There is other places in the state that take care of children and we work very closely with them as well. Here in Milwaukee, we’ve had 17 children hospitalized.

Frederica Freyberg:

Do you know, the experts and the medical professionals there, do you know what the long-term consequences of this kind of lung damage might be for these people?

Michael Meyer:

I think that’s the big question as we move forward with things. The treatment that we put in place was actually very good supportive care and used a lot of steroids in order to decrease the immune response and inflammatory response. Where we’re going to struggle right now is to really understand that if this is associated with vaping and that what chemical, what duration of exposure, and what does it look like 10, 15, 20 years from now because these are all unknown. Vaping has been around probably for 15 years. The last three to four years, we’ve seen an exponential increase in vaping in children. Children and their developing lungs we don’t know the long term effect of these vaping products. I think the one thing we do know is vaping is bad for kids and it is not approved for children.

Frederica Freyberg:

We describe this as a rapidly developing public health crisis. Do you continue to see cases?

Michael Meyer:

We haven’t seen a case for about two or three weeks now. We were averaging about one case per week while this was going on. We decided we needed to go public and make a public service announcement right around our sixth case because we thought it was a large enough cluster. By the time that we did go live in the state of Wisconsin sent out its provider advisory letter is we had eight children that we had seen by that time.

Frederica Freyberg:

What is it like for you and your physicians and your team to have been, as the governor says, at the forefront of this investigation?

Michael Meyer:

You know, when you hear your governor and your state senator talk about your team in that fashion, it does bring a sense of pride. I think that as traditional Wisconsinites, there’s going to be a great sense of humility and being humble. And most of us will look at this and say, “You know what? That’s what we’re here for.” Our job is to be the safety net for the health of our children and our community. And Children’s Hospital of Wisconsin and the medical college are part of community pride in especially southeast Wisconsin but for the entire state of Wisconsin.

Frederica Freyberg:

Dr. Michael Meyer, thank you very much for joining us on this.

Michael Meyer:

Thank you, Frederica.

Frederica Freyberg:

From health news to a closer look at education and the stubborn achievement gap problem in Wisconsin. It’s a problem State Superintendent of Schools Carolyn Stanford Taylor spoke to in her state of education address Thursday.

Carolyn Stanford Taylor:

Together we can have the difficult conversations about race and equity in our schools and our communities and tackle our achievement access and opportunity gap as the crisis it is. Too many of our students of color, students with disabilities, English learners, and students from low income families struggle to achieve their dreams and reach their full potential. We have to get learning right on the front end or Wisconsin as a state will never achieve true success.

Frederica Freyberg:

Superintendent Stanford Taylor will be a guest on next week’s program. The achievement gap is reflected in a big way in the 2018-2019 statewide test score results. Results that show a decline in student performance overall. According to the state Department of Public Instruction, student test scores show 40.1% of students were proficient or advanced in math. Down a percentage point from last year. Likewise, overall scores in English slipped to 39.3% of students testing proficient or advanced, down from 40.6 the year before. Again the achievement gap between white and black students also persists. For example, in the third grade 12% of black students were proficient in reading compared to 46.1% of white students. In math 15.7% of black students tested proficient compared to 58.5% of white students. The results caught the attention of members of the state legislature, including the chair of the Assembly Education Committee, Republican Representative Jeremy Thiesfeldt who joins us from his district in Fond du Lac. Thanks for being here.

Jeremy Thiesfeldt:

Thanks for having me.

Frederica Freyberg:

As chair of the Education Committee, what was your reaction when you saw these scores?

Jeremy Thiesfeldt:

Well, this is the fourth year that most of our students have been doing what’s called the Forward Exam. So we have a pretty good dataset available to us now that you don’t feel like you are making flippant judgments based on one year of data. So when I saw these results and I noted that there has been a pretty consistent downward trend through all four years of them, it raised some concerns on my part because I have a significant role and I appreciate having that role, but we can still take some comfort that Wisconsin is still ahead of most other states. But it is concerning to me that we most certainly are not headed in the right direction. Our scores are trending downward quickly. It appears to be trending downward quickly. And if you were to go into the subgroups in particular districts, you’ll find that there were drops in the scores as much as between 10 and 15% between year one of the Forward Exam and year four of the Forward Exam. It’s time for us to stop talking about this and do something about it.

Frederica Freyberg:

I want to ask you in a moment what you think we should do but you say that the legislature has “dedicated increasing amounts of funding toward K-12 every year since 2011.” But in the 2011-12 budget, GPR funding for schools was cut $426 million. How do you figure increases since 2011?

Jeremy Thiesfeldt:

That may have been an error on my part. I probably should have said 2012. I know there were some cuts in that first budget. There were cuts across the board in the budget. But since that time, there have been increasing amounts of dollars invested in education and particularly the last two budgets very healthy amounts. And we are simply not seeing results from that. Now, the standardized test scores are certainly not the only measure you would look it but it is a concrete measure and it is a valuable tool and these results are headed downward. And I do not believe that this is a money problem. I believe that this is a methodology problem. Particularly in our reading scores.

Frederica Freyberg:

So you were suggesting that we need to do something else. What do you think we need to do?

Jeremy Thiesfeldt:

Well, some of that is being formulated yet. I’m not going to produce a plan until I have a pretty good idea of which direction I want to go and until I’ve collaborated with some other stakeholders on the issue. But focusing in particular on reading because I strongly believe that reading is at the core of all academic studies. If you cannot — if you cannot effectively read, you cannot effectively learn. I don’t care what subject it is, you have got to be able to read in today’s world and read effectively at or above grade level in order to have — really have success in our world today. And so we have had and this goes back to even when I was in college back in the 1980s. And there was this whole language approach to reading that started to take hold. And that has permeated schools not just in Wisconsin but across the United States. And the results have been decreasingly — have been increasingly poor as the years have gone by. We need to return to a phonics-based approach to reading instruction. And this needs to start at our colleges and universities who train our teachers. And we have to find a way to get the professors of these schools to stop hiding behind academic freedom and seemingly going with whatever the flavor of the month is in academia, and go with what we know science tells us historically-based is how children learn to read effectively.

Frederica Freyberg:

We need to leave it there. I understand this is quite a controversy in the academic world. So Representative Thiesfeldt. Thanks very much.

Jeremy Thiesfeldt:

Thank you.

Frederica Freyberg:

We move now to the other side of the aisle. Democratic Representative LaKeshia Myers is also on the Assembly Education Committee. She is a former trainer of teachers at Milwaukee Public Schools and she joins us from Milwaukee. Thank you very much for being here.

LaKeshia Myers:

Thank you for having me.

Frederica Freyberg:

As we asked our last guest, what was your reaction when you saw the most recent student test scores?

LaKeshia Myers:

My initial reaction was to dive deeper. I take scores with a grain of salt because I know how they can be skewed. I know how it is for students to take a NAEP exam or the Wisconsin Forward Exam. I know what it’s like to guide students through that process. And you get a mixed bag of reactions from students who are tired of test taking and those who, you know, may just want to get it over with. And you may also get students who are genuinely nervous about taking assessments. And there are so many of them you have to look deeper into what the assessments actually curry. When you think about looking at the NAEP assessment, the NAEP assessment is one that is quite frankly graded harder than other assessments. What it takes for a student to be labeled as proficient is much more than it would be in — on most other assessments. So when I look at — go ahead.

Frederica Freyberg:

I was just going to say I get all that but why is student achievement as measured by these tests declining in Wisconsin in your mind?

LaKeshia Myers:

I think it can be a bit of test burn-out for students quite frankly. I think when you do the ACT, which is looked at as the gold standard in our state, however we have to look at the fact that not all students will be going to a four-year college or university where they may, quite frankly, not need the ACT assessment. I think when you look at alternatives of ACT like the ACCUPLACER assessment where students are going to a trade or technical college, they will take the ACCUPLACER versus taking the ACT, where it will grade them on skill base and knowledge base for the field that they’re planning to enter. So I think we have to look at everything and not just go down one particular path in grading students.

Frederica Freyberg:

Do you feel as though we should — you almost sound like you feel like we should do away with these standardized tests?

LaKeshia Myers:

Some of them. I think we should go back to proficiency-based assessments. They worked well especially when I was in school. They actually were used to measure what you were actually learning, not some foreign entity from outside of the state creating an assessment to say you should know x, y and z. Because as we know, testing and assessments in general, the numbers can be skewed. The assessments can be inequitable. I think there are different factors that go into looking at assessment data.

Frederica Freyberg:

Do you feel as though Wisconsin K-12 students are then actually better prepared for whatever they are going to do out of school than these results would show?

LaKeshia Myers:

Absolutely, more than likely yes. When I was in the classroom and training teachers for Milwaukee Public School there happened to be on the schedule that students were taking the ACT one day and the very next day they took the ACT work keys assessment. I can tell you that my attendance dropped the next day because students were not willing to invest the time necessary to a back-to-back test. So thankfully that has changed in recent years where we don’t continue to test our students back-to-back to back. I look at maybe quarterly assessments would be better and then judging students on a generalized proficiency-based assessment.

Frederica Freyberg:

What about the achievement gap as shown in these test results? How real is that?

LaKeshia Myers:

I think we’ve always seen achievement gaps especially between African-American and white students but I think one of the interesting takeaways from this recent batch of tests is that you see that white students are scoring lower on these assessments so we can’t really use that as a good gauge anymore. Because we never utilize the scores of Asian students which typically test higher above white students. I think when you look at something as a barometer, we have to go deeper into numbers and find out what is behind them.

Frederica Freyberg:

You definitely would have to go deeper within the numbers I imagine because I can’t imagine that anyone is going to do away with these standardized tests.

LaKeshia Myers:

Absolutely. I’m not saying they’re going to go away. I’m saying we need to re-evaluate what we’re assessing and how we’re looking at them.

Frederica Freyberg:

Representative LaKeshia Myers, I really appreciate your time and input.

LaKeshia Myers:

Thank you so much.

Frederica Freyberg:

Now to health news and a bad diagnosis regarding unpaid medical bills. The Wisconsin Hospital Association reports a 7.6% increase in 2018 in unpaid patient bills, also known as uncompensated care. The tab totals a debt of $1.2 billion owed to over 150 Wisconsin hospitals. These are expenses either patients refuse to pay or simply cannot afford. The total also includes charity care provided by hospitals at no charge to certain qualifying patients. We work through this development with Bobby Peterson, the director of ABC for Health, a non-profit law firm that helps people find affordable healthcare coverage. Thank you for being here.

Bobby Peterson:

Glad to be here.

Frederica Freyberg:

In your mind the overriding cause of this are efforts to undo the Affordable Care Act at both the national and state level.

Bobby Peterson:

Right, I think when you sow confusion, you get people more tentative applying for programs. They think they don’t exist. A lot of marketplace confusion out there. So it leads to people not getting the coverage that they need. When they get care, oftentimes they’re unable to pay for it.

Frederica Freyberg:

So included in this idea you say is that in Wisconsin, the Medicaid or BadgerCare program you describe the eligibility process as a corn maze. So does the difficulty in navigating the system, that corn maze, leave people just going uncovered or what are the implications that?

Bobby Peterson:

Sometimes. Right. Sometimes. I mean when you think about it, there are at least 16 different eligibility features between Medicaid and BadgerCare and then the marketplace and which way do you go? Parents are directed towards the marketplace. Children are directed towards BadgerCare+. Families might have split coverage, depends on their income. How is it attributed to their children? So it does, it creates a corn maze eligibility. You’re feeling your way through the process, trying to gain eligibility. Sometimes you miss out. Sometimes you give up. And when you do, and you have medical concerns and medical issues, it can often go unpaid.

Frederica Freyberg:

You also cite junk insurance. How does that contribute to people not paying for medical care?

Bobby Peterson:

Because the insurance isn’t paying what it should be. I mean if you think about comprehensive health insurance that covers most of your care needs. You know, insurance is changing so there is more co-payments and deductibles but we’re talking about specific solutions, policies that are temporary policies, association health plans. They’re really not as robust as what we see within the Affordable Care Act or typical private health insurance.

Frederica Freyberg:

Were these junk plans heretofore like during when ACA was in full force they didn’t exist?

Bobby Peterson:

They came — I mean the Trump administration has put forward rules that have made it easier for those plans to grow. Prior to the Trump administration, they were more specifically excluded.

Frederica Freyberg:

Would that be the case, too, with the kind of corn maze of the Medicaid program in Wisconsin? Did it have to do with tinkering around the edges?

Bobby Peterson:

Well, I think Wisconsin didn’t expand Medicaid so when we tinkered around the edges and said we’re could expand up to 100% for adults and expand up to 306% for some children, that creates different eligibility pathways so which way do you go out on the corn maze? For my kids, for myself, my income is fluctuating. I might be on or I might be off.

Frederica Freyberg:

Really complicated.

Bobby Peterson:

Seasonal employment or sales, farming income that could drop suddenly because of fuel costs or other things. There are a lot of variables out there. It’s hard for people to stay on top of.

Frederica Freyberg:

You also talk about surprise medical bills. What are those?

Bobby Peterson:

They’re not new to me because I have been practicing in this area for 30 years. But it’s basically sometimes when you have a bill that was unexpected. And typically it’s because you are paying beyond the usual and customary expenses. The hospital says we’re going to charge you $15,000 for this treatment. The insurance company says we only pay up to $10,000. So you typically sign a waiver and agree to pay beyond what the insurance company would pay. You think you’ve got coverage but suddenly you have a $5,000 bill because you have agreed to accept liability. You sign a lot of papers when you go into the hospital or maybe you do the touch screen. Sometimes it leaves you exposed to medical bills and liability.

Frederica Freyberg:

You say what happens in the uncompensated and charity care scenario is that it gets spread around to other hospital bills. So we’re basically all paying.

Bobby Peterson:

Right, at the end of the day, uncompensated care doesn’t just vanish and disappear. We talk about the socialization and redistribution of that debt into everybody else’s bill. It brings up the cost of healthcare in terms of higher costs, more expensive services because those debts don’t just disappear. They actually have to be absorbed in the other expenses of the health care facility.

Frederica Freyberg:

Isn’t that what the Affordable Care Act was looking to get at exactly?

Bobby Peterson:

Right. You think about it, pay me now or pay me later. If we are going to be pro-active and front end, let’s get good, comprehensive coverage for people, for kids. Let’s try and make it seamless so families and kids are together as much as possible. Let’s provide a comprehensive level of service and coverage. Because at the end of the day, if they incur medical debt they can’t pay, it ends up we all end up paying for it in the long run.

Frederica Freyberg:

Bobby Peterson, thank you very much.

Bobby Peterson:

Good to be here.

Frederica Freyberg:

That is all for tonight’s program. Next week State School Superintendent Carolyn Stanford Taylor will join us. I’m Frederica Freyberg. Have a great weekend.

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Funding for “Here & Now” is provided in part by Friends of Wisconsin Public Television.