Update: This transcript has been updated to reflect the current AP Stylebook guidelines.
Amantha Dickman, News Director: You’re listening to “KZUM News” on 89.3 KZUM Lincoln and KZUM HD.
[Fades in on the “KZUM News” program music, an original production of Jack Rodenburg. The music fades out.]
Amantha Dickman, News Director: Good afternoon and welcome to today’s edition of “KZUM News,” an hour dedicated to learning more about what is going on in Lincoln and the surrounding areas. I am the News Director, and your host, Amantha Dickman.
The seasons are changing, everybody.
I finally had to turn on my heat this week and had to switch over to fuzzy socks. I’m usually a staunch holdout when it comes time to switch from fall to winter, but, this year, I don’t think I have much of a choice. All I can hope for is a few warm days here and there, which will make me very happy.
With winter upon us, it is important to prepare, not only for cold weather but for the cold season as well. That’s why we are learning more with the November 2 Bryan Health Press Briefing on respiratory illnesses.
We also have some final information to wrap up our election coverage for the year. We’ll go over those Senatorial and Congressional results, and take a look at the changes that have happened in the last week. Then we have Kristi Egger – who won the County Public Defender seat – joining us to talk more about her plans for the office.
But, first, we have some relatively breaking news to help prep your morning.
We also have some reminders from Nebraska Game and Parks: they have announced that a second season is underway for limited river otter trapping.
The harvest season opened on November 1, providing those with a valid fur harvest permit an opportunity to trap one otter per season. The season will close on February 28, 2023 or three days after the 125th otter has been harvested in the state, depending on which event comes first.
Each day, before setting traps for river otters, permit holders much confirm the harvest limit has not been met and the season is open by calling 855 – 881 – 8905 or by checking the Game and Parks’ river otter season status webpage at Outdoor Nebraska.gov/OtterTrapping.
Any harvested river otter must be reported within 24 hours of harvest by contacting the nearest Game and Parks office, conservation officer, or by calling 855 – 881 – 8905. The otter must be tagged officially by Game and Parks within two business days after harvest, with the permittee furnishing the date and location of harvest before attaching the harvest seal. The otter should not be frozen. And you can check out the Small Game and Waterfowl Guide for a list of office locations and conservation officers at OutdoorNebraska.gov/guides.
The Nebraska Game and Parks would also like to remind the public that trapping is the only legal method of take. Harvesting is allowed statewide. But any incidental take of a river otter outside of the harvest season, or beyond the limit of one per harvester, is unlawful unless the animal is immediately released if viable or the harvester reports the take and turns over the carcass to Game and Parks.
This is because River Otters were extirpated from Nebraska by the early 1900s due to unregulated harvest. From 1986 to 1991, 159 otters were reintroduced into the state’s waters. Their recovery and subsequent delisting from the state threatened list in 2020 is due to successful conservation efforts in Nebraska. River otters now can be found nearly statewide with populations in most major river systems. As such, this season will provide data about statewide river otter distribution while continuing to allow the population to expand.
If you would like to buy a permit or are looking for more information, visit OutdoorNebraska.gov.
And, lastly, we have some updates on election results.
Last week, we were still waiting on the results of the United States Senatorial and Congressional elections.
At that time, Herschel Walker and incumbent Raphael Warnock were both sitting just below the 50% threshold needed to officially win the senate seat in Georgia. This led to Georgia confirming a runoff election to be held on December 6.
We were also waiting on the final results from Nevada, Arizona, and Alaska. Alaska has since confirmed that neither incumbent Senator Lisa Murkowski nor challenger Kelly Tshibaka had the votes to win outright. A statewide ranked-choice process will hopefully provide more answers.
Meanwhile, Nevada and Arizona have finished their counts. Both states have been confirmed as wins for the Democratic party, meaning the Democrats have kept control of the Senate for another term.
There were also several congressional seats up for reelection this year. While we are still waiting on reports from several districts across the United States, it has been confirmed that the Republican party has secured majority in the House of Representatives.
And, as this election wraps up, many of our elected officials are beginning to prepare for the next one. Former President Donald Trump has announced his plan to rerun for the presidency in 2024. While there has been no official announcement, President Biden has indicated that he is also considering a campaign for re-election. So we will be keeping an ear out to learn more. But, in the meantime, Lincoln has an upcoming city election happening this upcoming spring. This election will include a mayoral race and several city council seats up for election. Once we have a confirmed ballot, we will start our coverage a month ahead of the election so that you have a chance to learn more.
And that wraps up our relatively breaking news. But we are going to stick with the subject of election results for just a little while longer.
Last week, we went over our city, county, and state election results. If you missed that show, you can find it in our archives at kzum.org/kzum-news. But we did a deep dive into voter breakdown and had several guests talk about those results with us.
Joining us today, we have Kristi Egger. Ms. Egger ran for and won the Lancaster County Public Defender seat. And she is joining us here today to discuss her plans for the office.
Good morning. How are you?
Kristi Egger, Democratic Candidate for the County Public Defender Office: Good. How are you?
I have a crabby kitty.
Amantha Dickman, News Director: Oh no!
Kristi Egger, Democratic Candidate for the County Public Defender Office: The door is shut and she doesn’t like that, so you might hear meowing once in a while.
Amantha Dickman, News Director: Is she the stubborn kind who will try to claw under the door?
Kristi Egger, Democratic Candidate for the County Public Defender Office: She might. We’ll see. We’ll see what she does.
She just ran upstairs, so we might be good.
Amantha Dickman, News Director: Perfect. Then I’m gonna have you start off with the hardest question that we can ask you. Can you spell your name for us so that we have an ID tag?
Kristi Egger, Democratic Candidate for the County Public Defender Office: I can. It’s K-R-I-S-T-I. Egger is E-G-G-E-R.
Absolutely. Ms. Egger, you ran for and won the public defender position here for Lancaster County. Can you tell me a little bit about what experience you are going to be bringing to this position starting January… it’s first right?
Kristi Egger, Democratic Candidate for the County Public Defender Office: January 5. Yep.
Amantha Dickman, News Director: Well. Congratulations, again, by the way, just so that all our listeners can be reminded that you won.
Why don’t you tell us a little bit about your history and why you wanted to run for the position, and what experience you’re bringing to the table?
Kristi Egger, Democratic Candidate for the County Public Defender Office: Well, I have always been a public defender.
I grew up, went to Norris High School, kind of came to the university here in Lincoln, and did my undergraduate. I took a year off in between undergrad and law school to raise some money for law school. And I went to the university here in Lincoln, the College of Law. When I clerked, I clerked in the public defender’s office during law school. And when I graduated from law school, Lincoln didn’t have an opening in the Lancaster County Public Defender’s Office. So I went out to Hall County for a year to the public defender’s office there. And then when Dennis Keith, the former public defender, called me and asked if I wanted to come back to Lincoln and work in the public defender’s office here, I said yes.
And so I had been in the Lancaster County Public Defender’s Office from January of 1990 until January of this year. And I decided to retire early at 59 and run against the current public defender because it seemed like it was the right thing to do. When it was the right time to do it. I knew I would be able to have the financial wherewithal to not work for a little bit while I canvased and got out there and talked to people about why I was running.
And I’m very happy that I won in the primary election. And then in the general election, I was running against an opponent who has never worked as a public defender and has never worked in a public defender’s office. Even as a law clerk, I don’t think. And I think the experience that I have certainly put me in the best position to lead the public defender’s office. I know the staff, I know most of the attorneys. There have been a couple [of] hires since I left in January. And so I will… I’m looking forward to meeting those new people and getting back in the office, re-looking at the procedures, and policies, and just getting back in there and getting together with friends and representing clients again.
So I’m looking forward to that.
Amantha Dickman, News Director: And then you and Mr. Preble have done several debates together. Mr. Preble, for those who were not aware, being your opponent in the general election. And both of you stated that your top priorities was bringing transparency back to the office and maintaining office functionality. Can you tell me a little bit about why that is your priority and how you plan to do that moving forward?
Kristi Egger, Democratic Candidate for the County Public Defender Office: Well, transparency is kind of a wiggly term. I think some people use that for everything. But transparency I think means people can call the office, know what we’re doing, know about how many clients we have, those kinds of things.
We publish an annual report every year and so we are transparent in that our budget is clear, the number of misdemeanor cases that we took and conflicted out of or overloaded on, felony cases, appeals. All of that information and data is in the annual report. So, because we are a county agency, it is transparent always in that respect.
I want to have it be more transparent with me being in the office and able to talk to the public and be accessible and available. So that’s what my meaning of transparency means. My opponent’s transparency idea may have been somewhat different than that. But I think we ought to be out in the public more as public defenders. At functions and answering general questions like, “what’s your office do?” And just having a presence so that people remember that we are an agency, that we are appointed to represent people who can’t afford to hire private attorneys and we can answer general legal questions. If someone, say, gets a ticket for DUI over the weekend, drunk driving, and they’re new to the court system, they can call our office and ask questions. Like we can’t ever tell anybody what their sentence is going to be. But we can tell them the general court procedures, “Here’s what’s gonna happen at your first court appearance. Here’s the possible penalties for something. Here’s the legal issues that a person can challenge, like a motion to suppress statements or those kinds of things. Here’s the elements of what would have to be proved in a certain charge.” We’re available to answer those questions. And I think lots of members of the public don’t know that.
And so that’s my meaning of transparency, you know?
Amantha Dickman, News Director: Yeah. And then you said that one of those aspects that you’d want to be working on is being more out in the public and working with the public to bring awareness to your office. And I think that’s a really good segue because I noticed that, at plenty of the debates I attended, there was a lot of confusion about what the public defender’s office does among our people, our communities, and our citizens. So why don’t we talk a little bit about what it is the public defender’s office does?
I mean, you are primarily representing citizens who are facing legal ramifications of their actions that are brought against them by the county, correct?
Kristi Egger, Democratic Candidate for the County Public Defender Office: We are representing people who are charged with something that could cause them a loss of liberty. There’s no assumption that they have done anything wrong. They’re just charged with something. We live in a society that has the presumption of innocence. And so I think that’s important. Some people don’t understand that. They just think that [be]cause someone has been charged, that they’re automatically presumed guilty. And that’s not how our democracy works.
But we are appointed by the courts to represent people in juvenile cases who have been alleged to have committed a law violation or say a truancy matter where they’ve alleged to have skipped school. Those kinds of things. We are appointed in city attorney filed misdemeanor cases and county attorney filed misdemeanor cases. And a county attorney filed felony cases. We represent people in appeals. That’s where they are perhaps being sentenced to something or had a trial and got found guilty, and they’re challenging either the legal issues that happened during the trial or they’re challenging their sentencing.
We also represent people in mental health cases, and so we are appointed by the Mental Health Board to represent people who are alleged to be either a risk of harm to themself or others. And those hearings are held twice a week over at the Crisis Center, which is just right next door to the public defender’s office.
And we also do not responsible by reason of insanity reviews. And so that’s just generally what we are, what we have for cases. And that keeps us pretty busy. But it is for people who can’t afford to hire a private attorney. And so it’s for the judge to decide whether or not the person meets those qualifications for indigency.
And our job is to help people. So our job is to represent them and proceed how they wish to.
Amantha Dickman, News Director: You have that entire description so well mapped out compared to me. I was thinking of how I could describe that for listeners earlier and was not coming up with a very good response. Clearly.
Kristi Egger, Democratic Candidate for the County Public Defender Office: You haven’t worked in a public defender’s office, so you’re forgiven. It’s just fine.
Amantha Dickman, News Director: It’s true. I would not do very well in the courtroom. It turns out.
Kristi Egger, Democratic Candidate for the County Public Defender Office: You don’t know.
Amantha Dickman, News Director: No, I know.
And so you are working with a nice variety of cases there and sometimes you’re going to be working with people who have not been convicted but have maybe committed the crimes they are being charged with. Are you comfortable with that? Are there any cases, criminal cases, that you just would not work under any circumstances? And if so, why?
Kristi Egger, Democratic Candidate for the County Public Defender Office: We do not pick our clients. We do not pick the cases. The system is set up where the court appoints us, and the only reasons why we might not be able to take a case would be an issue where there would be what’s called a conflict of interest or we have to overload because we have too many cases.
The first example of a conflict would be, say, that there are three people that are charged with burglarizing a store. And those three people may have different interests. They may have given different statements to the police. They may have different arguments for wanting a trial. One person might say, “They forced me to do it,” or “I didn’t do it,” or “I have an alibi.” Or people may have conflicting interests in a case. And so we can only keep one person who is charged with a crime. And if there are co-defendants, then we need to get out of particular co-defendants and we may look at various things we may look at keeping a client that we have had on a previous matter for continuity of attorney-client relationship we may keep them because they might have another case pending.
And, so, that would have another case that we would be dealing with for them, it just depends. We have to look at a variety of facts and a variety of situations in determining who to conflict out of. And then private attorneys or the Commission on Public Advocacy Agency here in Lincoln, who deal with some of the more serious charges, and they deal with cases all over the state. And so it depends on who else the court would appoint for conflicts of interest.
Overload cases are a different matter. There are caseload standards that exist that are being currently modified. And it’s my understanding that a new study, a new scientific study has been done and that will be coming out in January. I think the American Bar Association may have had something to do with it. And other agencies certainly criminal defense attorneys associations have had a lot to do with reexamining the caseload standards because we don’t want a situation where we have too many cases and we can’t effectively represent our clients. And so those standards are being looked at and they should be coming out in January. So when I get into the office in January, I will have that to look at as well, that study. And then we will determine whether or not you know, how many possession of controlled substance cases can, can one person reasonably carry in addition to what else their caseload might be.
[Be]cause we don’t just have one type of case. We, as attorneys in the public defender’s office, deal with lots and lots of different cases. So, someone might have a juvenile caseload, but there are lots of various charges that someone could deal with on the juvenile docket. For example, there’s misdemeanors and felonies filed in juvenile court and dealt with in that situation.
So the overload situation is going to be far more complicated in the future because we’re gonna have those new standards to look at and then see how they apply. When we overload in a case, then private attorneys or the commission on public advocacy, they also get appointed. So I think it’s important to look at those new standards. Because private attorneys get paid now $125 an hour for just standard cases and $175 per hour in the more serious cases. So if the public defender’s office can keep more of the serious cases, we certainly save the county money then. And that’s good for taxpayers, it’s good for our society [be]cause then that money can go toward other things.
Amantha Dickman, News Director: Yeah. I’m so sorry, I didn’t mean to interrupt you earlier.
Kristi Egger, Democratic Candidate for the County Public Defender Office: You’re fine.
Amantha Dickman, News Director: I was just going to ask, is overload common these days in the office and how do you handle that kind of heavy caseload?
Kristi Egger, Democratic Candidate for the County Public Defender Office: Overloading is kind of common this year. It’s been especially bad. Well I left and then another experienced attorney came to take my place. So that didn’t cause an issue. But there have been other people leaving the office for a variety of reasons. And when we are short attorneys, then obviously we can’t take as many cases and represent as many people effectively. And so this year has been a kind of hard year for overloading.
What was your other question?
Amantha Dickman, News Director: Oh… just like… how do you handle that sort of overload? Do the offices – in years when there is a high volume of cases – does the office look at hiring more attorneys or do they change the way that workload is distributed?
Kristi Egger, Democratic Candidate for the County Public Defender Office: Overload in and of itself means that we get out of those cases. So that provides a little bit of relief in that respect. But then it shifts that onto the private attorneys and the commission on public advocacy.
As public defenders, we know that we are going to have busy caseloads. We know that we’re gonna have a lot of clients, and that’s just part of being a public defender. You realize that you need to focus on each individual client and then you’ve gotta move on to the next case because you’ve got a lot of clients and a lot of people to deal with, lots of cases in court, but that’s just part of being a public defender.
And that’s why having experience as a public defender and knowing the stress that we deal with, knowing the amount of cases that we deal with, I think it’s just important to have, to have that actual experience and knowledge in a public defender’s office. So, that helps and it helps to be better able to understand what your attorneys and the staff are going through as well.
So I plan to have a presence in court so that I can help [be]cause that’s what public defenders do. We are helpers. That’s why we got involved in public defense in the first place because we care about our clients, we care about the people that we work with, and we care about providing the best situation for the people in the office and our clients. And our main goal ought to be effective client representation. So whatever we can do to reach that goal. If that involves overloading on cases, then that’s what we have to do.
Amantha Dickman, News Director: Yeah. And then I’m gonna switch gears here just a little bit. I mean, clearly, you have extensive experience in the public defender’s office already, so I’m sure you’re prepared with an answer for this already.
But, in the last couple of years, there’s been a lot of mistrust between our citizens and our government facilities and agencies, and I’m sure that’s also true for the public Defender’s office. So when you have clients who are struggling with trusting or public defenders, what steps do you take to build that trust? Are there certain methods you utilize or is it just sitting down and talking to them?
Kristi Egger, Democratic Candidate for the County Public Defender Office: Public defenders overall are very experienced, and because we deal with so many different cases, we have a broad range of experience. And so I think that gives us more knowledge than some private attorneys might have because they just haven’t dealt with that wealth of information and amount of cases that we have.
People are people, whether they are poor or rich, and people need individual attention. And we need to overall care about listening to people, hearing their story, hearing their side, trying to understand their background, and asking questions.
And a lot of it has to do with caring about people and being willing to hear them out and process things with them. And so sometimes that just takes time. When people are in custody, that adds an additional level of stress for them and frustration because they can’t work, they can’t take care of their kids, they can’t pay their child support. They might lose their housing. It’s hard on people when they’re in jail. And we deal with poor people and poor people can’t post their bonds. They can’t get out of jail very easily. And so that adds a level of frustration for people. And we just… we need to try hard to be patient with people and understand where they’re coming from. And, that’s for everybody. You know, that applies to everybody.
Amantha Dickman, News Director: And then we do have three very specific questions that I heard pop up a lot at debates and forums this last election season. So the first of those is that people want to know more about the bail application process and how that’s prepared.
They came very informed, it turns out, to a lot of the forms and debates that you and Mr. Pebble did. So that was, that was one of the big questions was what does that process look like?
Kristi Egger, Democratic Candidate for the County Public Defender Office: There is a motion for bond review that the attorney files, if they wanna bring the matter back into court. An initial appearance for a person, whether they’re in jail or outta custody… While if they’re outta custody, usually the court just sets up what’s called a personal recognizance bond and they just have to be notified that they need to appear in court. The initial court appearance is where the judge sets a bond and that bond is set based on a person’s prior criminal history, the nature of the charge, those kinds of things.
And if we believe and our client believes that the bond is too high, then we file what’s called a motion for bond review and the matter. We give notice to the county attorney in the court, and the case is set for a bond review at the bond review. I normally talk about my client’s ties to the community, how long they’ve lived in town if they have children, if they’re married [their] significant other, other people to take care of what their responsibilities are. Are they employed? How long have they been employed there? Have they had any failures to appear in court? And if they did, why? Sometimes people miss court because they can’t get off work or they don’t have transportation. And, so, instead of thinking automatically that someone is irresponsible, we need to really think about their life and and why they may have missed court one time.
We need to look at the circumstances that are alleged in what’s called a probable cause affidavit, a little summary of what the county attorney thinks the case is about, written by the police officers or sheriff department. And we need to look at that and argue to the court why the bond should be lower or why there should be no money bond that is required. A person can be out on a bond and still have those responsibilities to be ordered to appear in court. And those kind of things.
A personal recognizance bond is where a person doesn’t have to pay any money to get outta jail. Most bonds, if they’re not a personal recognizance bond, require paying money. And so a $10,000 bond would require that a person pay $1000 to get out of jail. And that’s a lot of money for a lot of people. Many people don’t have that much money saved up to be able to get outta custody and then pay their rent or buy food. So you know, we need to shift to a system that would take into account just how hard bond is for people, how hard it is to post bond for many people in society where they may be living from paycheck to paycheck. They may not be able to buy food or keep paying their rent cause rent is pretty high. And if they have to pay that bond, that’s gonna negatively affect their life in a number of different ways.
And hopefully people in society are getting a better clue about the negative impact of making people sit in jail. It costs probably just over $100 per day for a person to sit in jail. And, if a person is out of custody, obviously they can be working, they can be taking care of their kids, they can be participating in society, buying groceries. Being a part of the economy where, if they’re in jail, it’s just costing taxpayers money.
And so, we really need to look at only having bonds in cases that involve violence or sexual assault cases. Very serious charges. [Be]cause holding people in jail for months and months [be]cause they can’t pay a bond that a person of more means could pay and be out, just is not fair to people.
Amantha Dickman, News Director: And you make a very good point and I will be very interested to see what changes Nebraska makes to that bond system if you get the chance to discuss it with all parties involved.
And it brings up another question that we’ve been asking all of our candidates, especially if they are involved in any form with our judges or our courts.
And that is… what role do you think that the Public Defender’s Office plays in reducing our prison overcrowding problem? Obviously last quarter they announced that they are at 152% capacity. I’m gonna have to double check that number before we air this, but yeah. What role do you think that your office plays? Or do you even think that you get to play a role? I know our judges do most of our sentencing, obviously.
Kristi Egger, Democratic Candidate for the County Public Defender Office: I think. Everybody in society has a role. And so it’s not that we don’t have a role, but we don’t have a lot of power. The power is in the County Attorney’s Office who decides what charges to file, who decides whether or not someone can get into a diversion program.
Diversion programs are for people who don’t have much of a criminal history and it allows them to be diverted out of the court system and supervised by community corrections or another agency. Mostly community corrections. And the county attorney has soul say whether someone gets in or out.
And I don’t think that’s quite fair. I think that it ought to be more than just the county attorney deciding that. I think that the county attorney needs to expand their… if they’re gonna maintain the final say, then they need to expand their rules and allow more people into diversion programs and keep people out of the court system from the very get go, if we can do that.
We also need to look at what the judges are doing. Back to the county attorneys. The county attorneys decide what charges they’re gonna file. And so if they’re going to consistently file the more serious charges for lots of different offenses, then obviously that’s going to limit what kind of plea agreement a person might get. The county attorney gets the final say on whether a client can plead to a lesser charge, and so the county attorney’s office has a whole lot of control and power, and so they need to rethink some of their policies. The judges need to – I hate to say this – perhaps be more educated about the impact that they have on our society when they throw people in jail for a long time or for prison.
And we need to think about other alternatives to sentencing. You know, they should be giving people more probation. People will have that supervision people. Need to be given chances if they mess up, say in drug court or veterans court or DUI court. People are getting a better idea lately, I think, of how many times a person needs to complete treatment in order to have that treatment be more effective and actually take root in a person’s life. People mess up and we can’t just throw the book at somebody cuz they messed up. It depends on the level of messing up, I think. But the county attorney and the judges certainly have so much power and the judges are the ones that sentence people to prison in the first place. And, so, if our prisons are overcrowded, frankly, that’s on the judges.
Certainly clients commit crimes and do things that get them sent to prison, but goodness sakes not everything. I’ve had people sent to prison on minor possession of controlled substance and I’ve had people sent to prison when they have done evaluations and done treatment and stayed out of trouble and did everything they could do. But the judge is looking only at their prior criminal history and the fact that it’s a felony and sending them to prison. I think my opponent had disputed that and clearly he’s not had enough cases in front of the district court judges if he thinks that people don’t go to prison for that.
So we need… frankly, we just need to not do that.
And the legislature also. They’re the ones who set the penalties. They can expand or limit judicial discretion, what the judges can and can’t do. And so they’re in control too. What the public defender’s office can do – back to your question – is we can try our darnedest to get people into diversion, to get people into problem solving courts.
Now, some people just don’t wanna do that, and that’s where they are in their life and that’s their decision. But I think we need to be sure that we are presenting that alternative to each and every [person] who would be eligible for those things and talk to them seriously about how this can make their life better.
Because having a conviction, a felony conviction especially, limits so much of a person’s life. You know? Their ability to vote, their ability to hold certain jobs and have certain licenses. It just… to get housing. Lots of those things have such a negative impact that we need to be persistent and persuasive in trying to get people into those diversionary and problem-solving courts.
But bottom line is we do for our clients, what they want us to do. And what they want us to ask for. So, I do think we need to be more vocal about cases that we think are unjust. If someone’s gone to prison, we can appeal. What we see is excessive sentences. But, oftentimes, you know, the public doesn’t know or doesn’t pay attention.
So we really, as public defenders, need to be out there in the community and then talking about some of the injustices that we see because we need to educate people.
Amantha Dickman, News Director: Do I take it that is a conversation that you are looking forward to having with Mr. Condon and our local judges then moving forward?
Kristi Egger, Democratic Candidate for the County Public Defender Office: Yes.
Amantha Dickman, News Director: All right. Well, it looks like we are beginning to run out of time, so we will need to be heading into our break here shortly. But, before we head out, thank you very much for joining us today, Ms. Egger. We appreciate you taking the time out of your schedule to sit down with us. And, of course, congratulations on winning the position.
Kristi Egger, Democratic Candidate for the County Public Defender Office: Thanks very much. Looking forward to getting back in the office.
Amantha Dickman, News Director: But, as I mentioned, we are sitting quite a bit past the half-hour mark. It is time for a quick break.
We have a couple of messages here for you but don’t change the dial. We are learning about respiratory illnesses from Bryan Health afterward.
[“KZUM News” transition music, an original piece composed by Jack Rodenburg, fades in and then out. KZUM Radio’s usual underwriting and public services announcements air at scheduled times throughout the hour.]
Amantha Dickman, News Director: Welcome back to today’s episode of “KZUM News.”
Before the break, we threw a bunch of information at you about river otter season harvesting and election results. So we are going to do a complete 180 and switch topics.
We attended the Bryan Health press conference about respiratory illnesses because it ‘tis the season. So we are diving in to learn more.
Edgar Bumanis, Director of Public Relations and Marketing at Bryan Health: Good afternoon. Edgar Bumanis with Bryan’s Advancement Team. Thank you for joining us.
Joining us today we have three physicians; Dr. John Trapp, Chief Medical Officer for Bryan Medical Center, Dr. Amy Pinkall, pediatric hospitalist, and Dr. Sian Jones-Jobst. Before we begin, I’ll quickly go over some Bryan Medical Center patient volumes.
In the last month, we’ve actually hit record census of 588 on two occasions. At midnight today, we were caring for 571 patients. Pediatric census: the unit is full. Six patients with RSV, two with Covid-19, and seven with non-respiratory needs. Covid? Our census is fluctuating between 15 and 25 per day. Today we have 12 with positive covid tests, seven who are resolved, and nine patients with pending tests.
And this last slide is a good segue to our first presenter, Dr. John Trapp
Dr. John Trapp, Chief Medical Officer for Bryan Medical Center: Thanks, Edgar.
I really wanna focus on the volumes in the hospital. You know, during the peak of the pandemic, it was not uncommon for us to hit numbers of 530 patients, 550 patients, and sometimes peaking up in the 570s. In the last few weeks, we’ve seen [an] even higher census where we’re consistently 550 into the 580 numbers.
This is a considerable expansion of the hospital capacity, a stretch on our workforce. And what we’re also seeing is increased volumes in our emergency department. We tried to expand our emergency department capacity the best that we can. We have expanded to hallway beds so that patients are still able to be evaluated and certainly emergency room volumes are higher than what we’ve seen ever in the past.
What all of this means is that getting into the hospital at Bryan Health has been challenging because of our high volumes. It’s not uncommon for us to have patients waiting in the emergency department for a bed, to get onto a medical unit or a surgical unit, or for patients at outside facilities, awaiting transfer to Brian.
All of this comes to the same time that we have concerns for other types of viral issues coming up. We’ve seen increases in RSV in our pediatric population. That’s been a concern. Last week we had 27 pediatric patients in a 17-bed pediatric floor. So we’ve had to expand that to some of our adult floors. RSV peaks over the next few months. So we will be expecting continued pediatric RSV cases during the months of November, December, and January. RSV not only affects pediatric patients but can affect adult patients as well, particularly those patients who are 65 and older, and certainly can cause significant hospitalizations and even death in those populations. So we expect to see higher virus… or higher patients with those types of respiratory viruses.
For our Covid-19 patients, we have been having, you know, a very steady census of Covid-19 patients. Anywhere from 15 to 30 as Edgar had outlined. Some of the concerns about Covid-19 is that we’ve seen some new variants that have developed throughout the world. Two of these variants, BQ1 and BQ 1.1 are two variants that have increased significantly in the United States. We’ve seen significant rises, particularly in the East Coast, where this is increasing numbers in excess of 20%. This virus has a doubling time where it increases in the population over about 10 to 14 days. It’s in the Midwest and slowly increasing.
If we look at projections, and again, during the pandemic, we saw significant waves of new variants. And what we saw in other areas of the country and across the world eventually made it to Nebraska. So we’re anticipating these waves probably hitting Nebraska in late November and through the month of December and maybe into early January. So that these variants have resulted in increased hospitalizations and deaths in other countries. And we anticipate that same risk for us.
So here we are in November. What comes in November? Typically influenza, another respiratory virus. And this year, influenza seems to have started a little bit earlier, maybe by six weeks or eight weeks earlier.
Typically, we follow waves of influenza that are seen in the southern hemisphere. And now we’re starting to see increasing numbers of influenza here in the northern hemisphere, which includes the Midwest. If this is a typical influenza season, we’re gonna continue to rise over the next four to six weeks. And so we expect to see peaks of influenza cases requiring hospitalization and utilization of resources, again, likely in the same period late November, early December, and probably stretching through into early January.
So what does this mean? This means that our hospital capacity is gonna continue to be strained. We’re gonna see high volumes in our emergency department and need for patients to be hospitalized because of these respiratory viruses. And this is a concern with regard to RSV and our pediatric population. We are meeting with our Region Seven – which includes Nebraska, Kansas, Missouri, and Iowa – to really understand how our capacity is and how we can access Pediatric Intensive Care Services for patients who might need this, as well as other hospital beds. Our team works closely with Children’s Hospital and you’re gonna meet two of our pediatricians today that help facilitate some of that work.
What can you do about these viruses that I’ve just mentioned to you?
What I think is important for you to be thinking about, as a community, is there’s still time to get your Covid-19 booster. The Bivalent Booster that’s out currently does seem to reduce the severity of illness and risk of death related to these new variants that are out there. As well, get your influenza vaccine. Again, after you get your vaccine or booster, it takes a couple [of] weeks for it to have the maximum effect. If we anticipate these viral loads increasing by the end of this month, you do have time. So my encouragement is for you to get boosted with your Covid-19 bivalent booster and to get your influenza vaccine. Thank you for the time.
Dr. Amy Pinkall, Pediatric Hospital: Thank you, Dr. Trapp.
I’m just going to touch a little bit more on RSV infection and RSV Bronchitis that we’re seeing here in Lincoln and really across the nation. So RSV is a virus that causes infection and it’s common in all ages. As Dr. Trapp said, most children are going to be infected with this virus in the first two years of life. Older kids and adults tend to get cold symptoms. The typical runny nose and congestion. But younger children, especially those under two, can become more ill with what we call Bronchiolitis and they can have much more severe symptoms. So they’ll have fever, coughing, increased work of breathing, hard time catching their breath, wheezing, low oxygen levels, high carbon dioxide levels. And we see that most especially in babies who are of a younger age and that were born prematurely, or children that have underlying health conditions such as heart disease or things like that.
And we’ve been seeing record numbers of RSV as Dr. Trapp mentioned, and we’re seeing it much earlier and much more of it than we have seen other seasons, and we anticipate that we’ll continue over the next few months.
Additionally, these children have been more sick than we typically see with RSV. We’ve had more children needing transfer to intensive care units, such as Children’s Hospital and Medical Center. And that’s been difficult for our babies. Unfortunately, there’s not any specific treatment for RSV infection. It’s really a supportive care. So we can give people oxygen, we can give breathing support. We can give IV fluids or tube feedings to help support their hydration and nutrition. But no medicine per se to make it better. Sometimes people ask about things like breathing treatments or steroids or antibiotics and, unfortunately, none of those are gonna help our kids get better faster.
So we expect to continue to see these high numbers of RSV and we really hope we can prevent some of that infection. There is no vaccine currently for RSV. So the best methods of prevention are avoiding sick contacts, good hand washing, keeping your child home if they’re sick, and otherwise staying generally healthy. So being fully vaccinated for other illnesses may help prevent that co-infection with other illnesses like influenza and Covid-19. All right, Dr. Jones- Jobst.
Dr. Sian Jones-Jobst, Pediatrician: Thanks Dr. Pinkall. So I’m a general pediatrician in the community and we are seeing quite a bit of RSV right now in the office, along with many other respiratory viruses some Enterovirus, Human Metapneumovirus.
It’s not uncommon, actually, when we do have kids who are seen in the emergency room and do get a viral panel that they have multiple viruses, two or more at the same time. But quite a bit of what we are seeing is RSV. We are filling our same-day sick appointments in the office, which is unusual this early in the season. Usually, that’s something that hits in late November, early December, and through January/February. So it’s definitely been an earlier rise and we are starting to see some influenza as well.
So, as Dr. Trapp and Dr. Pinkall said, please get your influenza shot. That will help to prevent some of those dual diagnoses of different viruses, which tend to be more significant in the office.
We wanna see your child who has increased work of breathing. Maybe they sound like they’re wheezing. They might have what we call retraction. So, when they breathe, their chest collapses a little bit because they’re trying to get air in and they can’t get air in. And so their chest collapses instead. If they’re having a hard time staying hydrated. Most babies with RSV Bronchiolitis and young children with RSV Bronchiolitis have a hard time staying hydrated because it’s more difficult for them to eat. That’s another reason to call your doctor’s office or to have them seen right away. And, definitely, if they’re very irritable, fussy. Or perhaps have a fever in children less than three months of age. If they have a fever over 100.4, we wanna see them in the office and make sure they don’t have something in addition to a cold or a viral URI. We also wanna see older… children older than three months of age if they have a fever over 104 or a fever that lasts for more than four days, or perhaps a fever that’s hitting at the end of an illness. It’s not unusual for children with RSV and other respiratory viruses to have secondary bacterial infections like ear infections or pneumonia.
So those are the types of things you wanna be watching for when babies come into the office. You can expect that they may have their oxygen levels checked. We’re gonna count their respiratory rates and watch to see how fast they’re breathing and listen to them. There’s no particular treatment, as Dr. Pinkall said, for RSV. But, really, what we do is teach parents to do supportive care at home. Most babies with RSV Bronchiolitis can be taken care of at home. They just require humidity to keep the mucus moist so it can move in the airway, frequent suctioning to keep that upper airway clear, and usually smaller volume feedings.
When they come to the office, one of our most important jobs is to see how well they’re breathing and make sure that, if they do need transfer to the hospital for more intensive care than can be given at home, that Dr. Pinkall can take care of them. So… and her crew, who we very much appreciate.
I would say there are some times where RSV Bronchiolitis could be an emergency at home, and it’s definitely something that you wanna take them in right away. Definitely, if you have a baby who’s extremely lethargic, not waking up for feedings, or appears like they’re not trying to breathe very hard. That’s a late sign that we really have some complications from RSV. And that’s a reason to take them in. And, of course, if they have blueness of the face or the skin or the lips or the fingernails, or if they look like they’re struggling to breathe, then they can’t get air or you’re worried about dehydration. So any of those might be a reason to take them in right away.
We don’t have a vaccine for RSV yet. And, so, right now one of the best things that you can do is to wash your hands. Stay home if you’re sick, if you have to be other around others and you have symptoms of illness, it does help to wear a mask. It does prevent spread to others with that source control. But RSV is really spread person-to-person and from contact with surfaces that are contaminated with the virus. So keep your hands away from your face. Don’t allow children and people to share beverages, to share things together. Even wiping down toys frequently if you have kids from different households that are sharing toys, can help to prevent the spread of RSV.
If you have a child who’s at higher risk of complications from RSV, as Dr. Pinkall mentioned, somebody who maybe was born very prematurely or is very small or still very young, less than six months of age, or has a heart defect and they have more difficulty breathing… those are kids that you wanna try to avoid going out in group situations.
Oftentimes, I’ll tell new moms and dads, you know, this is a great time to let individuals come to your home and say hello. Kick them out if they look like they’re sick. Even if Uncle Tom says it’s just his allergies, maybe he should not come to the house until he’s got those cleared. And then keep your baby… either wear your baby in a sling or a wrap or keep your baby in a carrier because people are less likely to try to help you by carry[ing] your baby or pass[ing] your baby around. So those are things to try as well, to help prevent the illness. Probably one of the best things that you can do is get your vaccine for Influenza C and I’ll put a plug in there too for Whooping Cough or Pertussis. We definitely don’t wanna see children with RSV, if we can avoid it. But, even more so, we don’t wanna see children with RSV and influenza. or RSV and Covid-19. Or RSV and Pertussis. And so the best way to protect young infants from these illnesses when they’re too young to be vaccinated is to go ahead and vaccinate everybody around them.
Children six months and up can get a Flu vaccine, children six months and up can get a Covid-19 vaccine. And everyone should get their Pertussis series. All the adults in the household should get their T-DAP if they haven’t had one in the last 10 years. So that’s probably the main things I’ll mention today.
I did see there’s a question about an RSV vaccine. We have had exciting news in the last week. There is a potential RSV vaccine that Pfizer has said that they’re gonna submit to the FDA sometime before the end of 2022 for approval. This is a vaccine, not for children for RSV, but for pregnant mothers.
So the idea is you give the pregnant mother the RSV vaccine, they develop antibody, it passes to the infant, and then, when they’re born, which is at their highest risk point for having complications from RSV, they should have antibody on board. It looks like it is about 80% effective in preventing severe RSV and hospitalization, and about 50% effective in preventing RSV infection itself. So that’s great news for those of us who take care of some of these infants. But we don’t have it yet, so we’ll have to stay tuned for that.
Edgar Bumanis, Director of Public Relations and Marketing at Bryan Health: Thank you, Doctor.
The other question already submitted through chat deals with the high numbers of rsv. The question is ‘“could it be because people kept their children at home more and they weren’t able to build up immune systems to fight RSV?”
Dr. Amy Pinkall, Pediatric Hospital: Hi. I’ll just speak to that question. That’s a good question. It’s not related to them being home and not building up their immune system. RSV is a virus that we see every year all the time. There’s different strains of it each year and some years it’s just more prevalent and more virulent and this just happens to be one of those years. And most of these children that we’re seeing with the severe infection are under two years of age and even under one year of age. So they haven’t been around to be exposed to RSV prior to this.
Edgar Bumanis, Director of Public Relations and Marketing at Bryan Health: Any other questions? I’ll give it just another minute to see if anyone else has anything else to submit.
As always, if you have any follow-up questions, please reach out to Brad.
All right. With no other questions. Thank you everyone for joining us. Thank you Physicians for joining us.
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