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March 29th, 2023:

So what happens with CD18 now?

Mar 29th, 2023
by Charles Kuffner.
7 comments

This story is a very basic explainer about Rep. Sheila Jackson Lee’s just-announced Mayoral campaign. There’s only so much it can tell us as she has not yet talked about what her top campaign priorities are, and most of the rest we already know, but this bit at the end is worth discussing.

Do people line up for Jackson Lee’s seat in Congress?

The congresswoman does not need to resign to run for mayor, and if she does not win, she can keep her post in Congress. Still, will people line up to succeed her in the storied 18th District if she wins?

One such candidate, former At-Large City Councilmember Carroll Robinson, wasted no time Monday in announcing he was considering a run for Jackson Lee’s seat. Mayor Sylvester Turner, who is term-limited, also lives in the 18th District, although residency is not a requirement for congressional elections.

I discussed this in my previous post, so I will briefly reiterate that Rep. Jackson Lee does not have to resign to run as noted in this story, but logistically it may be sensible for her to do so. She doesn’t have a limited legislative calendar like Whitmire does (and Mayor Turner did before them) and she has longer and more arduous travel to endure if she wants to multitask while campaigning. I don’t know what she will do, and I certainly won’t be surprised if she remains in office through the election, but there is a clear argument that she would be better off stepping down.

Let’s assume that she remains in office. If she wins outright in November, or if she fails to make a runoff, it’s easy enough for her, because the filing period for the 2024 primaries is November 11 (after the election) through December 11. Where it gets tricky is if she makes the runoff, which per usual is the second Saturday of December. That would be December 9 this year, meaning she would just have enough time to re-file for CD18 if she falls short. That sure wouldn’t leave much time to recover and rebound from what would surely be a tough loss, and it could be very awkward if in the meantime a flood of credible contenders have filed for CD18, but she could attempt to go back to Congress if she fails to become Mayor.

If she does win, either in November or the runoff, then there would need to be two elections to succeed her: A special election to serve out the remainder of her term, and a Democratic primary to determine a nominee for the November 2024 election. Both would likely draw large crowds, with some but not full overlap. It is certainly possible to have a situation where the special election winner is not the Democratic nominee for November. If the same person manages to win both, they may have to win four races – the special, the primary, and a runoff for each – to get there. (They would have to win in November as well, but CD18 is strongly Democratic – SJL got 71% last year – so it would be the least competitive race by far of them all.) It would be exhausting and a little confusing since the special election runoff would likely occur after the primary but before the primary runoff. We had a four-race situation to replace Garnet Coleman in HD147 after he stepped down; in 2016 we managed to replace Mayor Turner in HD139 in only three races, as now-Rep. Jarvis Johnson won the primary in the runoff but took the special election on the first try. (Again, not counting the November election; both districts are strongly Dem and both Rep. Johnson and Rep. Jolanda Jones were unopposed in their Novembers.)

Note that everything I wrote about above would also apply to SD15 and Sen. John Whitmire. I wrote about this in January, when Whitmire drew a two-year term for this cycle, meaning that there will be a general election for SD15 next year. If he had drawn a four-year term then there would still be a special election to replace him in 2024 if needed, but the primary election for that seat would have been in 2026. Them’s the breaks. If we get a Whitmire-Jackson Lee runoff, we might have a situation in which both candidates would be thinking about what their Plan B is, assuming they hadn’t already made any definitive statements about that. Isn’t this fun?

As for the potential candidates to run in CD18, all I’ll say for now is that the list will include a lot more people than the opportunistic Carroll Robinson. Mayor Tuner has been cited as a possible candidate for US Senate in 2024, which I don’t believe, and I’ve heard his name mentioned as a possible candidate for SD15, a prospect I find marginally more credible. I feel roughly the same about him as a CD18 candidate. The likely suspects here, for either of these offices, will include current State Reps and Senators and HISD/HCC Trustees and City Council members, various other former officeholders and candidates, and quite possibly a current Mayoral candidate or two. It’s difficult to see, always in motion is the future. Ask me again in six months.

HISD decides against appealing TEA takeover to the TEA

Mar 29th, 2023
by Charles Kuffner.
Comments are off for this post

The decision makes sense, whether or not the headline to this post also makes sense.

In a close vote, Houston ISD board members decided late Monday to bypass its final appeal of Texas Education Commissioner Mike Morath’s decision to takeover the district.

Earlier this month, the board overwhelmingly voted to end the lawsuit against the TEA. They still had the option to file an appeal to the state agency,  considered a last-ditch effort at preventing state intervention. These appeals hearings are not held in court but rather by a committee the commissioner selects and often do not go in the district’s favor. The board ultimately voted 5-4 against the measure.

“When it was time to give up the legal fight because we didn’t have a legal basis to continue, I was on board with that,” Trustee Myrna Guidry said. “This is an appeal that is given by the commissioner himself, giving us one more opportunity … The outcome is on the commissioner, but I believe we should take the appeal so we as a board have done everything we possibly can.”

Last week, the TEA hosted a series of informational meetings about the state intervention, which was met with outcry from the community. Shortly after the TEA’s takeover plans were announced on March 15, the community rallied in opposition to the intervention. This type of response is worth listening to, said Trustee Patricia Allen.

“I’ve heard the voice of the people. I’ve been to the community meetings. My opinion as a trustee is to listen to the voice of the people,” Allen said. “This is not a ‘must’ on the part of the commissioner. We can appeal and the commissioner can decide.”

[…]

Trustee Judith Cruz agreed the district should not spend any more money on legal counsel regarding takeover issues.

Others said they felt their chances of success with an appeal were too slim to pursue.

“Whether we file an appeal or not, there is no changing in the outcome,” Board President Dani Hernandez said. “It’s time to make a smooth transition.”

I lean in the “not worth it” direction, mostly because asking the TEA to reconsider its own decision seems highly unlikely to work. I get where Trustees Guidry and Allen are coming from, though. There might be some symbolic value in making the TEA defend itself on the record. Basically, I agree with Campos, I don’t have a quarrel with anyone’s vote on this.

Another “future doctor shortage” article

Mar 29th, 2023
by Charles Kuffner.
1 comment

Third in the series. This one covers our future nurse shortage, too.

More than a year and a half after Texas implemented its six-week abortion ban, and months after Dobbs, medical providers say they are facing impossible situations that pit their ethical obligation to patients who are dealing with traumatic and dangerous pregnancy complications against the fear of lawsuits, loss of their medical licenses, and incarceration. The problem is encapsulated by a lawsuit filed this month in Texas, in which five women and two OB-GYNs sued the state over the abortion bans that they say have created so much confusion and fear among providers that it has affected women’s health and even threatened their lives. Unsure of how to comply with the new rules, hospitals have interpreted them differently, with some requiring approval from attorneys or ethics boards for physicians to provide abortion care in medical emergencies, and others leaving it up to individual doctors, with little guidance or support. This has meant that some physicians wait until patients are near death to intervene in medical emergencies, according to recent research, court filings, news reports, and interviews. “I’ll get consults from another doctor asking me what to do in a particular case—a mother bleeding, or a pregnancy where there’s an infection in the womb before the baby can survive outside the womb. I have doctors calling me, hesitating, not quite knowing what to do because the baby has a heartbeat, when clearly the mother’s life is at risk,” John Visintine, a maternal fetal medicine specialist in McAllen, Texas, told me. “These are things that I haven’t seen in, you know, 20 years of practicing OB, 14 years of practicing high-risk OB—I’ve never run into these situations where people are wondering what to do.”

The inability to provide what they say is the standard of care to pregnant patients is taking a toll, personally and professionally, according to interviews with more than a dozen doctors and nurses across Texas. And it’s causing many, like Wilson, to reconsider the future of their career in the state. Almost every provider I spoke with for this story has thought about leaving their practice or leaving Texas in the wake of S.B. 8 and Dobbs. Several have already moved or stopped seeing patients here, at least in large part because of the abortion bans. “If I was ever touch a patient again, it won’t be in the state of Texas,” said Charles Brown, chair of ​​the Texas district of the American College of Obstetricians and Gynecologists (ACOG), who stopped seeing patients last year after decades working as a maternal fetal medicine specialist. Many asked that their hospital affiliation not be included in this story, in some cases because they feared consequences from their employer or the public for speaking out about these laws, even though they’re not breaking them. Some worry about what will happen to their own kids if they are targeted. Several cried through the interviews. Many of those I spoke with who haven’t left yet are still thinking about it regularly—people who have family and homes and lives in Texas and would not otherwise have considered moving.

Brown put the stakes bluntly: “Are people quitting? … The answer is yes,” he said. “I hope I’m 100 percent wrong about this, but I think it’s a much bigger trend that’s going to become obvious pretty quickly.”

[…]

This is all happening as Texans can’t afford to lose more access to medical care. In 2022, 15 percent of the state’s 254 counties had no doctor, according to data from the state health department, and about two-thirds had no OB-GYN. Texas has one of the most significant physician shortages in the country, with a shortfall that is expected to increase by more than 50 percent over the next decade, according to the state’s projections. The shortage of registered nurses, around 30,000, is expected to nearly double over the same period. Already, Texans in large swaths of the state must drive hours for medical care, including to give birth. According to recent research from the nonprofit March of Dimes, it is among the worst states for maternity care access, which has decreased in a dozen Texas counties in the past two years, mostly due to a loss of obstetrics providers.

This doesn’t yet take into account the effects of increased criminalization of abortion care, which is further compounded by dramatic pandemic-induced burnout among clinicians. As physicians retire, hospitals are struggling to replace them; as nurses burn out or leave for more lucrative travel nursing roles, their positions are sitting open. There have been a string of policies and factors that have stretched providers in Texas for many years, from having the highest uninsured rate in the country to low Medicaid reimbursement rates to the demonization of science to attacks on transgender health care, and now the abortion bans, according to Tom Banning, the CEO of the Texas Academy of Family Physicians. “The first rule of holes, when you’re trying to get out of the hole, is to stop digging,” he said. “We just continue to dig the hole that we’re in deeper.”

This is an issue for both urban and rural areas, but it’s felt most acutely outside major metros, where one retirement or move can be the difference between having access to medical care near home or having to drive an extra several hours. The state has experienced the most rural hospital closures in the country in recent years. Less than half of rural hospitals nationwide still have labor and delivery services, according to recent research from the Chartis Center for Rural Health; in Texas, that number is just 40 percent. John Henderson, the president and CEO of the Texas Organization of Rural and Community Hospitals, said he gave a presentation this fall for a group of representatives from about 100 rural Texas hospitals where he asked them to raise their hand if they don’t currently have openings for registered nurses. “There were three out of 100 that were fully staffed, and I was actually surprised that there were three,” he said. “It’s crisis-level staffing for the majority of rural Texas hospitals.” Maternity wards have long been the sacrificial lamb for cash-strapped rural hospitals trying to save money and keep their doors open, but more recently, it’s short staffing that has forced closures and cuts to services in Texas and across the country.

See here and here for the previous entries. The problems with rural hospitals and the general unavailability of maternity care are separate but related phenomena. I realize that the plural of “anecdote” isn’t “data”, but there sure are a lot of anecdotes, and some of them do come with data, so.

It is of course possible that none of this gets beyond the anecdote stage. Some of the people quoted in the story admit that it’s tough to leave even as they get pushed past what they thought their point of tolerance was. Maybe the effect will only be truly felt in rural areas where they keep on voting for the Republicans that create and exacerbate these problems for them. Maybe it’s dumb to expect Republicans to feel the consequences for any of their actions, given that they haven’t felt them for the freeze or for the continued epidemic of mass shootings. I don’t know what’s going to happen. But as long as these stories keep getting written, I’ll keep pointing them out.