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State_and_regional
HHS rejects guidance on baby deaths and injuries

LINCOLN — Child welfare officials have rejected recommendations for change based on a probe into the death or serious injury of four Nebraska babies, according a report released Tuesday.

Inspector General of Nebraska Child Welfare Julie Rogers released the report, which included her findings from investigating the four cases. All four involved infants whose siblings already had been removed from their homes for abuse or neglect.

Rogers made five recommendations based on her investigations. They include adopting a policy for assessing the safety of a baby born to parents involved with the child welfare system and requiring consultation with a supervisor when a new baby is born to parents who are no longer involved with the system because they have given up their rights to a sibling.

The Nebraska Department of Health and Human Services rejected all five recommendations related to those cases but accepted two others in the report.

In a letter, CEO Dannette Smith said the department already has a protocol for reassessing families involved in the child welfare system when circumstances change, such as through the birth of a child. She said HHS is studying how other states handle similar cases before making any changes to the protocol.

“(We) will not make changes to protocols that are not thoroughly researched and consistent with industry best practice,” she said.

Smith said Tuesday that HHS takes all recommendations seriously and has completed, is making progress or needs to take no further action on about 89% of the inspector general’s recommendations over the years.

“Our decision to accept or reject specific recommendations is made around the overall strategies we are pursuing to move the Division of Children and Family Services forward,” she said. “The safety and well-being of all children in Nebraska is a priority for the department, and it continues to look at strategies to strengthen the child welfare system.”

Rogers expressed disappointment with the department’s response, saying it did not address the specific problems raised by the four cases.

“Caseworkers and supervisors need more than these generalities when faced with complex cases such as these,” she said. “It’s my hope that HHS will propose more specific solutions to solve the gaps in our child welfare system as a result of these tragic events.”

But Rogers praised HHS for making progress on previous recommendations. She noted work on improving home studies, regulating foster care providers and training of agency staff and foster and adoptive parents on preventing sexual abuse and exploitation. She pointed particularly to improvements in caseload sizes for child welfare workers, though she said the state has not met the standards set by law.

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According to the annual report, the four infant cases occurred between 2014 and 2018, but investigations wrapped up this year. Each involved a baby left in the care and custody of a parent or parents who had previously abused or neglected a young child.

An example was the case of a 1-month-old girl, called “Gracie S.” in the report. She was brought to the hospital after being found limp and unresponsive in her crib. Doctors found multiple fractures on both sides of her skull and bleeding in her skull and brain. She died after being taken off life support.

According to the report, Gracie’s mother, called “Heather,” had been imprisoned previously after being convicted of felony child abuse of her then-6-week-old son. Heather told investigators at the time that she had a hard time coping with the stress of caring for a newborn. The son remained in a placement away from his mother when Gracie was born.

After Gracie’s birth, child welfare workers assessed her situation. They concluded she was safe in her mother’s care but said she was at high risk. The workers recommended ongoing services; however, there was no follow-up or monitoring done.

As in that case, Rogers found that all four infants were left with parents who got no additional services, that the parents’ progress in the siblings’ cases was mischaracterized and that caseworkers and supervisors got little help coping with the trauma they encountered on their jobs.

The report detailed a separate investigation into the case of a 14-month-old who died in the care of a foster mother. The child had been placed with that foster family, despite previous recommendations not to place children under the age of 2 with that family. HHS accepted the two changes that Rogers recommended in that case.

Office of Inspector General of Nebraska Child Welfare Annual Report 2018-2019

According to the annual report, the Inspector General’s Office reviewed 590 cases between July 1, 2018, and June 30 this year. The total includes 243 from HHS, 71 from juvenile probation and three from other sources.

The report said Rogers has been forced to abandon an investigation into three suicides and 15 suicide attempts by youths under the supervision of juvenile probation.

She launched the investigation in April 2018 to look for systemic issues involved with the incidents and see if any recommendations for improvements could be made. But as of June 2018, she said, the Administrative Office of Probation blocked her from interviewing probation staff and denied her requests for data, making the investigation impossible.

State Court Administrator Corey Steel said the Nebraska Supreme Court required that staff have attorneys present during interviews and that all questions had to be submitted in advance. He said the court thought Rogers was overstepping her mandate.

The inspector general and probation officials have clashed ever since probation took over responsibility for juvenile offenders from HHS.

Probation officials have not accepted Rogers’ past recommendations, citing “separation of powers and judicial independence.” Probation is part of the judicial branch of state government. The inspector general’s position is within the legislative branch.

Meet the Nebraska state senators

News
Grace: Meet Special Agent Johnson, the top federal cop in charge of Nebraska and Iowa

I couldn’t break her.

Kristi Koons Johnson, Omaha’s newest FBI special agent in charge, the first woman to head the Omaha bureau, was warm and friendly in our interview. But not too revealing, even with softball questions. She’s usually the one in the question-asking role.

Guilty pleasures? The 47-year-old smiled and couldn’t think of any offhand.

Favorite TV shows? See above. Except, Johnson allowed, “The Crown.”

Books? She prefers historical fiction.

Hobbies? Running. “Actually, for fun,” said Johnson, who has run the Omaha-to-Lincoln “Market to Market” relay along with the Lincoln half-marathon and the Des Moines marathon. She also loves to travel and has been to four continents.

During an interview cut short by one ill-fated wrong turn (by me), one trip back to the car to leave my phone (per FBI rule), one trip through security (heels off) and a stark, formal interview room, I tried to learn about the new top federal cop in charge of Nebraska and Iowa.

I learned Johnson was from Michigan, and her mother is a Canadian citizen. I learned that her father died after a heart attack when he was 45. Johnson was just 6 years old.

Her mother went to work as a telephone operator at Ford Motor Co.’s headquarters in Dearborn, and a grandmother pitched in on child care. Johnson and her two older siblings had to grow up fast: They had to be brave, disciplined and independent. They had to work hard.

I learned that Johnson had her eyes on the FBI early, joining at age 26 after finishing college at Michigan State University, where she got to study in Australia, thus catching the travel bug. She graduated from law school at the University of Detroit.

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I learned more about an impressive résumé that includes: Over a decade in Illinois, where Johnson worked on anti-corruption investigations involving organized crime and public officeholders. That included one Rod Blagojevich, the disgraced former governor of Illinois who served from 2003 to 2009, when he was impeached and removed from office.

The Democrat was convicted of federal corruption charges — including trying to sell an appointment to the U.S. Senate seat being vacated when Barack Obama was elected president in 2008. Blagojevich was sentenced to 14 years in federal prison, where he remains.

“That was an extremely interesting one,” Johnson said.

During her FBI tenure, Johnson has served as temporary assistant legal attaché abroad in Moscow and Athens. She has taught organized crime investigation tactics in El Salvador. She has worked on FBI policy at the bureau’s Washington, D.C., headquarters.

Johnson calls herself “a policy geek.”

“I love the law,” she said. “So I love the rules.”

She has served in leadership before in the Omaha division office, most recently holding the title chief division counsel, a role that advises on law enforcement and intelligence investigations and supports the bureau’s litigation efforts.

She held that local FBI leadership role during two major Omaha office investigations. One involved a Chinese national who tried to steal hybrid corn seed technology from companies DuPont Pioneer and Monsanto in Iowa as part of a larger trade secret theft conspiracy.

More recently, Johnson was assistant special agent in charge during the investigation of the death of Sydney Loofe, the Lincoln store clerk who was murdered and dismembered. The FBI worked with the Lincoln Police Department and Nebraska State Patrol. In July, one of the two people charged was convicted; the other awaits trial.

Johnson met her husband, Chad, an Iowa native and also an FBI agent based in the Omaha office, while in training in Quantico, Virginia. They met doing pushups. Who did more?

Johnson smiled and demurred.

“It was,” she recalled, “a good challenge.”

The couple owns and lives on a working farm in Iowa.

The FBI remains a boys club among some 13,000 special agents, where just one in five is a woman. Even fewer women are in positions of leadership. Of 56 field offices, just nine are led by women. Johnson succeeds Randall Thysse, who retired.

The FBI’s deputy director, Dave Bowdich, said the agency needs “leaders from all different backgrounds, experiences, and perspectives.” He said in a statement that he was “confident her experience and expertise will greatly benefit the community.”

Johnson said she has not encountered sexism within the bureau, and she’s never felt any barriers to her own career advancement.

“Any female who might be interested” in an FBI job, she said, “should not be deterred” from seeking one.

If Johnson was reticent about getting too personal, she also was not going to weigh in on the current tumult in the FBI, which has lost two directors in two years, or on the U.S. Department of Justice, which is weighing criminal charges against ousted acting director Andrew McCabe. McCabe had replaced James Comey, who was fired by President Donald Trump.

A local spokesman said those questions should go to the national press office.

I was kidding when I said I couldn’t “break” Johnson. That wasn’t the aim of our interview. And she isn’t a completely closed book. She was gracious and professional and I read her reticence as being important in a line of work that relies more on listening than on talking.

Her focus is on mission: countering violent extremism, including homegrown mass shooters; conducting counterintelligence; busting fraudsters.

Internet-based fraud is a particular threat, costing Nebraskans and Iowans at least $24 million last year. The crime hits vulnerable populations, like the elderly, and the FBI thinks the actual amount lost is much higher than what has been reported.

The local FBI office also continues to work with local, state and federal law enforcement partners on drug and gang issues.

Johnson said it was important to be “100% ready for any critical incident.”

“We care about this community,” she said. “And we are focused on ensuring every member of this community feels the same safety and security that we want our families and friends to feel.”

Photos: National landmarks of Nebraska

Health
Jack Hoffman, 13, plays in first school football game, 6 years after his Huskers touchdown run

Andy Hoffman never expected his son to put on pads in an organized football game.

Despite battles with brain cancer, 13-year-old Jack was able to take the field for his first school football game Monday.

Making it even more special, Jack became the fifth Hoffman man to sport the No. 75 on the gridiron.

“Overwhelming is the best way to explain it,” Andy Hoffman said. “We’re just so thankful that God gave Jack this opportunity.”

Jack, from Atkinson, Nebraska, was diagnosed with brain cancer in 2011 and underwent chemotherapy. He soon was befriended by Husker star Rex Burkhead and drew national attention in 2013 when he ran for a 69-yard touchdown in the Huskers’ spring game. His family has rallied behind its nonprofit, the Team Jack Foundation, which raises funds for pediatric brain cancer research.

BRYNN ANDERSON/THE WORLD-HERALD 

Jack Hoffman was 7 when he entered the 2013 Husker spring game and quarterback Taylor Martinez guided him to daylight on the way to a 69-yard touchdown run. Jack took home an ESPN award for the year’s best moment in sports.

Jack relapsed in 2014 and participated in a clinical trial. His tumor showed signs of worsening in 2018, and now Jack is undergoing treatment similar to that of the clinical trial.

Because of the brain tumor, Jack also has epilepsy and is prone to seizures, his dad said. He takes 23 pills a day, some to manage epilepsy and others for cancer treatment.

Jack, now taller than Dad, comes from a football-loving family. His dad and uncles all played the sport. Grandpa is a big fan.

“This isn’t something that we’re shoving down his throat,” his dad said. “This is Jack wanting to play football.”

His parents checked with Jack’s doctors, who said it was their decision. Mom and dad spent months praying about what to do. Ultimately, they let Jack decide.

Most days, he forgets he has a brain tumor and lives his life like a typical eighth grader. On the field Monday night was no different. Jack, who played center, was like his peers: He had fun.

His dad said they hear the good stories from families affected by brain tumors, but they also hear sad, difficult stories from people they’ve met through the foundation. They realize Jack is fortunate, and they’re thankful.

“I’m happy Jack got to do that and I’m just overwhelmed,” Hoffman said. “I’m sad, on the other hand, that other kids don’t get these opportunities. My heart breaks for those kids. Who knows what the future holds, but we’re going to enjoy it while we can and let tomorrow worry about itself.”

Hoffman said the family is grateful to Nebraska, Husker fans and the football program for ongoing support of pediatric brain cancer research in Nebraska. Research and treatment of the disease continue to need support, he said.

The Hoffmans will take each football game as it comes and reevaluate based on Jack’s health, Andy said, but he makes the most out of each day.

“All any of us are promised is today,” he said. “Whether you have a brain tumor or not, you should make the most out of today. That’s what Jack’s doing.”

A roundup of inspirational stories from Midlanders with heart

Articles
Vapers seek relief from nicotine addictionby turning to cigarettes

Lucas McClain started smoking cigarettes in high school but switched to vaping after he heard e-cigarettes were a safer alternative.

His vape of choice became the Juul, the king of electronic cigarettes — which comes with a king-size nicotine hit.

Now 21, McClain wants to quit so badly that he's turning back to the problem he fled in the first place: good old-fashioned cigarettes.

"Juul made my nicotine addiction a lot worse," the Arlington, Virginia, resident said. "When I didn't have it for more than two hours, I'd get very anxious."

Even though McClain knows the dangers of cigarettes — lung cancer runs in his family — he thinks it might be easier to kick cigarettes than his Juul. Plus, his mom keeps warning him about the mysterious vaping-related illnesses that have sickened hundreds across the country.

So last month, McClain bought his first pack of cigarettes in years. Then he tweeted about it.

"Bought a juul to quit smoking cigarettes," he wrote, "now I'm smoking cigarettes to quit the juul." He ended with this hashtag: #circleoflife.

One Juul pod, which provides about 200 puffs, contains as much nicotine as a pack of cigarettes. On stressful days, McClain could finish a pod in three hours — and as he and others figure out just how potent these and other e-cigarettes are, many want out.

Some are turning back to combustible cigarettes — or taking them up for the first time— in a dangerous bid to lower their nicotine intake and ultimately get off their vapes.

"Isn't it ironic that to quit juul I bought cigarettes," says one Twitter user. Another points out that it's "strange" that she used the device to quit smoking cigarettes but is now "far more addicted to my Juul than I ever was to cigs."

"It sucks," she said. It isn't a complete surprise that some young people are "going back to the product they were trying to quit in the first place," said Pamela Ling, a professor of medicine at the University of California-San Francisco who studies tobacco and its marketing.

But it is worrisome because cigarettes contain toxins and chemicals that are dangerous to their health, she said.

Vaping may not be safe either. The Centers for Disease Control and Prevention is investigating at least 380 cases of lung disease in 36 states — mostly among young people — possibly linked to vaping nicotine and marijuana. Six people have died. California is investigating at least 60 cases.

The back-to-smoke trend flies in the face of the e-cig industry's most insistent PR pitch: Vaping helps people quit smoking cigarettes. In fact, San Francisco-based Juul Labs, which commands 75% of the e-cig market, says in its mission statement that the company aims to eliminate cigarettes by giving adult smokers "the tools to reduce or eliminate their consumption entirely."

In an emailed statement, Juul didn't directly address the decision by some of its users to revert to cigarettes, but again clung to the refrain that its products are "designed to help adult smokers switch from combustible cigarettes to an alternative nicotine delivery system."

Ted Kwong, a Juul spokesman, said Juul is not designed to get people off nicotine or to treat nicotine dependence.

For those who criticize Juul's high nicotine content, Kwong noted that pods come in two strengths — 5% and 3% nicotine concentrations — letting users customize their "switching journey."

In early September, the Food and Drug Administration reprimanded Juul for promoting its products as being safer than cigarettes without FDA permission.

Vaping has become big business, with the global market projected to hit $48 billion by 2023.

Smoke or vapor, cigarette makers win either way. Altria, which sells Marlboro and other tobacco brands in the U.S., invested nearly $13 billion in Juul for a 35% stake last year. Altria has proposed reuniting with Philip Morris International, a unit it sold off in 2008.

Even though the industry says vaping is intended for adults, Juul and other vaping pens took off among young people about two years ago when teens began taking the devices to school and teachers mistook them for flash drives. Students took hits in campus bathrooms and halls, and even in class when teachers weren't looking.

The e-liquids inhaled from the devices contain nicotine and come in thousands of fruity flavors that appeal to kids.

Earlier this month, Michigan became the first state to ban sales of flavored e-cigarettes in an attempt to end teen vaping. In June, the San Francisco Board of Supervisors banned the sale of all e-cigarettes, beginning in early 2020. Juul is fighting back with a November ballot measure, Proposition C, backed by millions of its own dollars.

Many former smokers attest that vaping was the only thing that helped them quit cigarettes, but the science is mixed. Some studies have shown that many vapers continue to smoke cigarettes.

The FDA has approved seven treatments for smoking cessation, including patches, gums and lozenges. Vapes are not among them, said Dr. Elisa Tong, an associate professor of medicine at the University of California-Davis.

Tong said vapers may be using more nicotine than they realize. She understands why some choose to go back to cigarettes, but she doesn't recommend it.

"What they're doing is trying to taper down super high levels of nicotine," she said. "Unfortunately, manufacturers don't have a manual on how to quit their devices."

Dr. Amanda Graham, senior vice president of innovations at the Truth Initiative, an anti-tobacco advocacy group, said she is seeing "desperation and misguided approaches" from teens and young adults trying to free themselves from nicotine.

"Young people are fumbling in the dark with what seems logical," Graham said. "But there is no safe level of cigarette smoking."

Early this year, Graham's group launched a digital program to help teens and young adults quit their vaping devices. Since then, 41,000 people between 13 and 24 have enrolled in "This is Quitting," which sends them tips and support via text messages.

Chris Gatus of Whittier, California, switched from traditional cigarettes to Juul because he thought the device would help him quit smoking, he said.

But because his Juul is always glued to his palm, he found himself using it everywhere and all the time.

"I've sort of forgotten what it's like not to be on nicotine," said Gatus, 21.