Why Keep Secrets About Texas Women’s Health?

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Three weeks ago, news broke that Senator Jane Nelson, chairwoman of the powerful Senate Finance Committee, was deeply unhappy with a study published in The New England Journal of Medicine titled “Effect of Removal of Planned Parenthood from the Texas Women’s Health Program.” Here’s the finding that raised Senator Nelson’s ire:

Our data are observational and cannot prove causality. However, our analyses suggest that the exclusion of Planned Parenthood affiliates from the Texas Women’s Health Program had an adverse effect on low-income women in Texas by reducing the provision of highly effective methods of contraception, interrupting contraceptive continuation, and increasing the rate of childbirth covered by Medicaid.

On February 12, Senator Nelson sent Health and Human Services Commission Executive Commissioner Chris Traylor a letter, stating her objections to the article (she calls it a “report,” which it clearly is not–it’s a peer-reviewed academic article). The letter includes specific data to back up her assertion that there has never been more care available to Texas women. She also requests that HHSC essentially perform a study to refute the findings of the NEJM article.

In her letter, Nelson argues, with vehemence, that this study cannot be right because it does not take into account other programs that provide contraceptive care for low income women in Texas. Essentially, Nelson’s argument goes along the line that the article was wrong because the authors chose to limit their research to apples, and she only accepts research about apples that also includes oranges. There’s no studying just apples–gotta include oranges, too, even if the apple study yields some provocative results. How dare they not talk about my orange groves? (There’s an excellent op-ed by Toni Inglis in today’s Austin American Statesman that dissects Nelson’s argument and explains the review process involved in medical journals. Pull quote: “My money is on the Journal, not the Texas senator, to determine the validity of a research study.”)

Read alone, this letter seems like just another in what has come to feel like a familiar aria from Senator Nelson. We’ve heard it before: she hits all the high notes in her defense of Texas women’s access to care, despite the cutting Planned Parenthood out of the Women’s Health Program in 2011 and the state’s difficulty in implementing a replacement program, which was well-documented in the 2013 legislative session. Texas is putting more money into women’s health care than it ever has before. There’s a whole lot of oranges to talk about, forget those apples. It’s her song, and she likes to sing it. No big deal.

Suddenly, one of the co-authors of the article, Dr. Rick Allgeyer, retired from the Texas Health and Human Services Commission, where he worked for over 20 years. Then everyone got the message that this is a distinctly new tune.

Edgar Walters reported in The Texas Tribune on February 18, “State Employee Steps Down After Women’s Health Study,” that the resignation of Dr. Rick Allgeyer, a co-author of the article and HHSC employee, was confirmed by HHSC spokesman Bryan Black. According to Walters, Black stated that Allgeyer’s work on the article was “moonlighting,” and “broke policy by working on the study during his workday. He should have never been putting in time on this study during the normal business day, he was paid to perform state business.”

Apparently, contributing to leading research publications is not state business.

The problem with this argument is named Dr. Michael Honeycutt.

Dr. Michael Honeycutt is the director of the department of Toxicology at the Texas Commission on Environmental Quality. And according to a search on research.net, he is listed as an author or co-author on 25 articles published in a variety of research publications (including one that’s new to me, The Journal of Unconventional Oil and Gas Resources). I’m personally familiar with Dr. Honeycutt’s work on carcinogens found in the air surrounding Texas refineries from my work on environmental regulatory legislation in the 2009 and 2011 legislative sessions. I seem to remember that his scholarly credentials were something the state prided itself on.  But then again, I’m pretty sure that Dr. Honeycutt never contributed to an article that may have been construed as critical of state policy.

There’s been more news this week: There’s been additional correspondence between Commissioner Traylor and Senator Nelson about the HHSC leadership team’s awareness of this research and publication, and Traylor demanded that The New England Journal of Medicine “take the state’s name off” the article. NEJM responded by adding this note at the end of the article:

The views expressed in this article are those of the authors and do not necessarily represent the views or policies of the Texas Health and Human Services Commission.

Again, why all the fuss? Did anyone really think that this could possibly be the state’s official position? It’s about apples, for God’s sake, and we all know that in Texas we don’t talk about apples unless we talk about oranges. Could Dr. Allgeyer’s co-authorship really pose that much of a threat? How many people are going to know about this article, unless you start writing letters to each other about it that get covered in the Texas press? It’s gotten to the point where this entire situation would seem simply absurd if the lives of actual women were not involved.

But they are.

Unfortunately, it’s not absurd. It’s how Texas operates at the highest level. We need to be able to understand what’s really going on, what the data says about the Women’s Health Program, and about the other programs Senator Nelson claims have exceeded the care provided previously. We need more than dramatic letters. We need a calm, clear accounting of both the facts and the thinking that make this response to this article appropriate, and then a very candid and clear analysis of what is, and what is not, working for Texas women.

On February 19th, I sent a request for public information to the secretary of the senate requesting email and other documents from and to Senator Nelson and her staff in relation to the New England Journal of Medicine article. I wanted to understand the basis for her opinions, the data she was requesting of HHSC, and how she came to her knowledge about the article before its actual publication.  I sent this letter as per the Public Information Act, which allows ten business days for a reply.

On Monday, March 7, I received a letter from the secretary of the senate informing me that she was seeking a decision from the Attorney General that would “except” certain documents pertaining to my request, essentially protecting Senator Nelson from having to produce a documents related to her role in this controversy. I knew that it was possible that my request for records would be sent to the Attorney General’s office. The small number of documents I did receive do not include a single email to or from Senator Nelson herself; they are exclusively from and to her staff members.

It’s really not surprising that the secretary of the senate has sought an exception to making Senator Nelson’s emails about this controversy, if there are any, public. But is it ironic. One of Senator Nelson’s constant themes is that she wants Texas women to understand that state leaders have not really cut essential health care for women, despite what they may have read, what they may have heard, what they may have experienced. She wants Texas women to trust their elected leaders and their state government to care for them.  She seems genuinely offended when people suggest that she cannot be trusted on this issue. It seems very personal to her. And I can understand that–this issue feels very personal to me as well. But I think providing Texans with as clear a picture of her thinking and her correspondence could go a long way to encourage that trust. So what’s to keep her office from making more documents public? Did she really not write one email that isn’t too sensitive to be shared? Or receive one? Perhaps she doesn’t use email, but then there’d be no documents for the attorney general to except from my request.

According to the state, the purpose of the Public Information Act is to promote transparency in government. Ken Paxton himself says so in his introductory letter on the inside cover of the 2016 Public Information Handbook published by his office:

The Texas Public Information Act sets requirements for the ability of citizens to access information on action taken by governmental bodies. This transparency provides Texans with a more complete understanding of how their government works, and, when necessary, provides them an opportunity to hold their public officials accountable.

Paxton’s letter concludes:

Providing public access to the governmental decision-making process creates necessary trust and understanding in officials and in the system. It is my hope that the Handbook will help promote an open and inclusive system of government in Texas that benefits all of our citizens.

I agree, General Paxton. Trust and understanding are essential for good government. I hope you’ll permit me access to the governmental decision-making process and allow me to read the emails and documents that inform Senator Nelson’s opinion and have the appearance of being related to the resignation of Dr. Allgeyer. I still believe in an open and inclusive system of government in Texas that benefits all of our citizens. I hope you do, too.




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