Wednesday, January 16, 2019

UK removes dean who was defendant in suit ending in payment of $620,000 to professor who objected to Bevin's Medicaid plan

Stephanos Kyrkanides (University of Kentucky photo)
The University of Kentucky has removed the dental-school dean whose alleged retribution to a faculty member resulted in a $620,000 settlement with the professor and his restoration to the payroll.

Dr. Stephanos Kyrkanides ended the post-retirement employment of Dr. Raynor Mullins in 2017, after Mullins and other College of Dentistry faculty members objected to the withdrawal of dental and vision benefits from the state's standard Medicaid plan, as part of a package of changes advocated by Gov. Matt Bevin.

A federal whistleblower lawsuit by Mullins initially alleged that the move was prompted by a call Kyrkanides received from Bevin, an administration official, or Mark Birdwhistell, the UK HealthCare vice president who helped the administration draft the plan; and that Kyrkanides told Mullins to make no more public statements about the plan, and "communicated that this direction came from 'up top'." Bevin's office denied any knowledge of the allegations.

A revision of the suit dropped Birdwhistell and an unnamed Bevin administration official, identified only as "John Doe," as defendants. They were later dismissed, but without prejudice, meaning they could have been reinstated. That left Kyrkanides as the only defendant. In December, as the case was heading to trial, UK and Mullins settled the matter and issued a statement saying they would have no further comment on it. Mullins has been rehired to run a new oral-health program.

On Wednesday, Provost David Blackwell, the university's chief academic officer, sent an email to faculty and staff in the dental school, saying:
As of this morning, Dr. Kyrkanides is no longer the Dean of the College of Dentistry. He will begin a 1-year sabbatical/administrative leave immediately, but remains a faculty member in the College. I thank Dr. Kyrkanides for his service to the College and University during his time as Dean.

I will soon be meeting with the leadership team of the College to discuss interim leadership. During this time of change, I urge each of you to stay focused on your excellent work in teaching, research, service, and patient care.

We will be arranging meetings with faculty and staff in the near future to discuss next steps for the College. Thank you very much for your contributions to the Commonwealth, UK, and the College of Dentistry.
Asked if the move was voluntary or involuntary on the part of Kyrkanides, who had been dean since 2015, Blackwell referred the question to university spokesman Jay Blanton, who did not immediately respond.

Mullins' suit roused concern among UK faculty, even though post-retirement positions do not have traditional protection of tenure for professors. At the December meeting of the University Senate, the faculty's governing body, fine-arts professor Herman Farrell noted the settlement and told UK President Eli Capilouto that the claim of a "response coming from the governor's office" with "consequences to that faculty member . . . really does affect academic freedom, and it frightens me as a faculty member." He asked Capilouto if "at some point in the future that you would take a sort of a more sort of proactive approach to what was implicated there."

Capilouto said, "There was a contention in this case about intervention by governmental officials. That part of the case was thrown out. I know no circumstance where the governor or anybody in the governor's administration said anything to undermine academic freedom. I've been here seven and a half years. I've never had an elected official -- I've served under two governors -- tell me anything about someone's employment, period. Especially no one has ever said anything to me, employment-related, to what someone said -- and you say controversial things, and it is my responsibility to defend you when you say, and that's where I stand on it."

Shortly after the suit was filed, Capilouto said in a university-wide email that UK "has a deep and enduring commitment to academic freedom. Our regulations protect it, and our values hold it sacred. No member of our community will be punished for expressing their views on matters of public concern."

Foundation for a Healthy Ky. adds 28 new members to its Community Advisory Council, most from Friedell Committee

The Foundation for a Healthy Kentucky has added 28 new members to its Community Advisory Council, bringing its total up to 49.

Of the new members, 27 were formerly members of the Friedell Committee for Health System Transformation, which united with the foundation in December.

The Community Advisory Council advises the foundation's board of directors on overall policy and strategic direction. Members also serve as liaisons with Kentucky communities, putting the council at the center of a strategy shared by both the foundation and the Friedell Committee to expand community engagement statewide.

LeChrista Finn, an associate professor at Kentucky State University in Frankfort, is the newly named chair of the council. The new vice chair is Tim Marcum, regional director of planning at Baptist Health in Louisville. Both have served on the council since 2014.

"Council members, new and existing, are among the most mission-minded health- and health-policy advocates in the Commonwealth of Kentucky," Finn said. "I am grateful that members of the Friedell Committee have stepped up, once again, to work toward a healthier Kentucky."

The 28 new council members are: Constance Alexander, Murray, writer, consultant, and civic journalist; Charlotte Beason, Louisville, retired executive director of the Kentucky Board of Nursing; Dennis Chaney, Bowling Green, Barren River District Health Department director; Tracey Clark, Hopkinsville, executive director of the Jennie Stuart Health Foundation; Danny Duncan Collum of Shelby County, a writer and professor at Kentucky State; Al Cross, Frankfort, journalist and University of Kentucky professor and director of its Institute for Rural Journalism and Community Issues, publisher of Kentucky Health News; Colette Crown, Lexington, former administrative coordinator for the Friedell Committee; Barbara Hadley-Smith, Frankfort, retired government and private sector communications executive; Ann Hagan-Grigsby, Louisville, chief executive officer of the Park DuValle Community Health Center, Inc.; Richard Heine, Lexington, former executive director of the Friedell Committee; the Rev. Nancy Jo Kemper, Lexington, retired executive director of the Kentucky Council of Churches; Rev. Terry Lester, London, retired pastor at First Baptist London; Sylvia Lovely, Lexington, president of, Sylvia Lovely & Associates and former executive director of the Kentucky League of Cities; Kathryn Mershon, Louisville, independent hospital and health care professional; Dr. J.D. Miller, Lexington; retired Appalachian Regional Healthcare executive; M. Raynor Mullins, Lexington, emeritus faculty, dental public health, University of Kentucky; Judy Myers, Lexington; faculty member at Indiana University Southeast School of Nursing; Mark Neikirk, Highland Heights, executive director of the Scripps Howard Center for Civic Engagement at Northern Kentucky University; Marty Newell, Whitesburg, chief operating officer, Center for Rural Strategies; John Rosenberg, Prestonsburg, director emeritus of Appalachian Research and Defense Fund of Kentucky and vice chair of the Kentucky Public Advocacy Commission; Sheila Schuster, Louisville, executive director of the Advocacy Action Network; Dr. Doug Scutchfield, Lexington, emeritus professor at UK College of Public Health; Rich Seckel, Lexington, executive director of the Kentucky Equal Justice Center; Susan Stokes, Louisville, owner Access Community Assistance and former state representative; Lisa Tobe, Louisville, executive director of Wildflower Consulting; Tom Walton, Louisville, executive in residence, University of Louisville School of Public Health and Information Sciences; Dr. Pat Withrow, Paducah, cardiologist and director of outreach at Baptist Health Paducah (the only new Council member who did not come from the Friedell Committee); Charlotte Whittaker, Hartford, president of AARP Kentucky and former executive director, Ohio County Senior Services.

These members join Finn, Marcum and the following existing Council members: Nancy Addington, Elizabethtown, retired director of the Area Agency on Aging at the Lincoln Trail Area Development District; Tracey R. Antle, Russell Springs, chief operating officer of Cumberland Family Medical Center; Angela Carman, Berea, assistant professor in the UK College of Public Health; Roger Crittenden, Frankfort, retired circuit and district court judge; Sandra Duverge, Louisville, Health Equity Program Manager at Passport Health Plan; Fran Feltner, Hazard, director of the UKCenter of Excellence in Rural Health; Deborah S. Fillman, Owensboro, retired director of the Green River District Health Department; Liz Durst Fowler, Lexington, president and CEO of Hospice of the Bluegrass; Amanda Goldman, Lexington, system director of quality and wellness for Catholic Health Initiatives and director of diabetes and nutrition care at KentuckyOne Health; Randy Gooch, Nicholasville, director of the Jessamine County Health Department; Laura Hancock Jones, Morganfield, dentist at Union County Family Dental; Michael Keck, Science Hill, vice president at Five Talents Financial Group; Keith Knapp, LaGrange, associate professor at Bellarmine University; Sherry Lanham, Beattyville, director of the Lee County Family Resource Center; Matthew Minier, Louisville, director of student success at the Southern Baptist Theological Seminary; Wynn Radford, Hopkinsville, retired insurance agent; Robert Slaton, Georgetown, health-care consultant; Melissa Slone, Hazard, research interdisciplinary director for the UK Center of Excellence in Rural Health ; and Johnny White, Russellville, organizational development manager at Constellium.

Tuesday, January 15, 2019

16 Kentuckians on Medicaid sue Trump administration again over re-approved Medicaid program, say it still violates federal law

By Melissa Patrick
Kentucky Health News

Kentucky's new Medicaid program, which includes controversial work and community engagement requirements was recently re-approved by the Trump administration after a judge rejected it. Now the plan is back in federal court after 16 Kentucky Medicaid enrollees filed an amended complaint to the original class-action lawsuit.

The 88-page amendment, filed Monday night, says nothing of substance was changed when federal officials re-approved the plan, so many of its new requirements continue to violate federal law.

The plan website: https://kentuckyhealth.ky.gov/Pages/FAQ.aspx
The state's new program, called Kentucky HEALTH for Helping to Engage and Achieve Long Term Health, includes, among other things, work or other community engagement requirements; monthly reporting; lock out periods for failure to comply; and income-based premiums. It is set to launch April 1.

Just days before the program was originally set to roll out in July, U.S. District Judge James Boasberg of Washington, D.C. vacated it and sent it back to the U.S. Department of Health and Human Services for review, ruling that, among other things, HHS Secretary Alex Azar had not fully considered the state's projection that in five years the Medicaid rolls would have 95,000 fewer people with the plan than without it.

Boasberg found the approval of Kentucky HEALTH "arbitrary and capricious" because the federal government had "never adequately considered whether Kentucky HEALTH would, in fact, help the state furnish medical assistance to its citizens, a central objective of Medicaid."

The amended lawsuit has been filed in Boasberg's court, despite Gov. Matt Bevin's efforts to have it moved to Kentucky. Defendants and interveners have until Jan. 28 to respond, including motions for dismissal or summary judgment.

The Southern Poverty Law Center is among the counsel for the plaintiffs. Samuel Brooke, the center's deputy legal director, said in a news release, “The Trump administration’s desire to explode Medicaid and transform it into a work program seems to have no limits. After being declared arbitrary and capricious last year, the administration has now issued a virtually identical re-approval letter; it should face a similar fate and be declared illegal,"

The plaintiffs' lawyers argue that the work and community-engagement requirements, income-based premiums, cost-sharing for non-emergency use of emergency rooms, lockout penalties for violators, removal of retroactive coverage, and removal of non-emergency medical transportation -- and Kentucky HEALTH as a whole -- don't promote the objectives of the 54-year-old Medicaid program.

They argue that each of those measures is "categorically outside the scope" of what is allowed under the guidelines for a waiver of the Medicaid rules; that these new requirements don't qualify as "experimental, pilot or demonstration project(s), nor (are they) likely to promote the objectives of the Medicaid Act;" and that the federal government has "relied on factors which Congress has not intended them to consider, entirely failed to consider several important aspects of the problem, and offered an explanation for their decision that runs counter to the evidence."

In addition, the lawyers claim that a Jan. 11, 2018 letter from the Centers for Medicare and Medicaid Services to all states' Medicaid directors. laying out a path for approval of work and community-engagement requirements under a waiver of the original Medicaid rules, should not have been issued without a formal hearing process.

The suit also notes that the state has said it seeks to "comprehensively transform Medicaid" through Kentucky HEALTH, that the director of CMS has stated the need to "fundamentally transform Medicaid" and the Trump administration has "repeatedly expressed its hostility to the Affordable Care Act and its desire to undermine its operation," violating the constitutional requirement that the president "take care that the laws be faithfully executed." The suit says "The power to 'transform' a congressional program is a legislative power vested in Congress."

The Bevin administration has long said the goal of Kentucky HEALTH is not to kick people off of Medicaid, but to empower individuals to improve their health and help them shift to employer-sponsored coverage, and to ensure the program's financial stability. The state has estimated that it would save about $2.4 billion over five years.

Adam Meier, secretary of the state Cabinet for Health and Family Services, said in an e-mail, “The cabinet is not surprised by the refiling and will continue to work toward implementation of the Kentucky HEALTH waiver. Kentuckians, and specifically our Medicaid members, deserve a Medicaid program that will improve health outcomes and provide paths for employability, long-term stability, and future success while also ensuring the long-term sustainability of Medicaid for those who need it most."

The lawyers disagree, saying in their preliminary statement: "Purporting to invoke a narrow statutory waiver authority that allows experimental projects 'likely to assist in promoting the objectives' of the Medicaid Act, the [HHS] secretary is working to effectively rewrite the Medicaid statute, ignoring congressional restrictions, overturning a half century of administrative practice, and threatening irreparable harm to the health and welfare of the poorest and most vulnerable in our country."

Medicaid covers 1.4 million Kentuckians, including almost half of a million under the previous administration's 2014 expansion of eligibility to people with incomes up to 138 percent of the federal poverty level.

Only four of the 16 Medicaid enrollees listed on the amended complaint were part of the original lawsuit; 12 new plaintiffs have been added. The amendment describes each one's situation in detail. They are represented by the National Health Law Program, a public-interest law firm; the Kentucky Equal Justice Center; and the Southern Poverty Law Center.

The defendants are HHS, CMS and their top officials. It also names the Commonwealth of Kentucky, which filed an unopposed motion for intervention, which was granted on March 30, 2018, as a "defendant-intervenor."

Boasberg's original 58-page decision is at: https://ecf.dcd.uscourts.gov/cgi-bin/show_public_doc?2018cv0152-74.

Kentucky abortion-bill backers hope their measures might lead the U.S. Supreme Court to end legalized abortion

State Sen. Damon Thayer (Northern Kentucky Tribune photo)
Kentucky legislators' recent filing of anti-abortion bills isn't just about the state; they hope the bills could make national impact.

"Emboldened by two conservative justices added to the U.S. Supreme Court in the past two years, a top Republican legislator believes Kentucky could be at the forefront of an effort to end legalized abortion nationwide,"Deborah Yetter reports for the Louisville Courier Journal.

"I would be proud if it's Kentucky that takes it up to the Supreme Court and we change Roe v. Wade," the 1973 decision that created a right to abortion, said Sen. Damon Thayer, the majority floor leader in the Kentucky Senate. Such a feat would be "the pinnacle of my career."

Yetter notes that Kentucky lawmakers have said they aren't worried about the costs of litigation that would likely result if a bill to ban abortion once a fetal heartbeat is detected, around six weeks of pregnancy, is passed into law.

"I don't think you can put a price on the life of the unborn," Thayer told Yetter.

Such legislation, Senate Bill 9, sponsored by Sen. Matt Castlen, R-Owensboro, has already passed out of the Senate and now resides in the Republican led House. Yetter reports that supporters anticipate a quick final passage of the bill, which has an emergency clause that would allow it to take effect immediately.

Opponents of the "fetal heartbeat bill" say it amounts to an unconstitutional ban on abortion, since most women don't know they are pregnant until after six weeks of pregnancy and ultrasounds to determine the health of the fetus aren't typically done until the 14th week of pregnancy.

Brigitte Amiri, deputy director of the American Civil Liberties Union Reproductive Freedom Project, told Yetter that such efforts are deliberate: "This is to take a direct challenge of Roe v. Wade to the Supreme Court in light of changes to the Supreme Court."

President Trump's appointments of Justices Neil Gorsuch and Brett Kavanaugh have led many to believe that the court has a solid 5-4 conservative majority, that is primed to overturn the 1973 decision and others stemming from it.

But James Bopp Jr., a prominent conservative lawyer based in Terre Haute, Ind., who regularly tries cases before the Supreme Court and who served as general counsel to National Right to Life, a leading opponent of abortion, disagrees.

Bopp and associate Corrine Youngs wrote in an Oct. 19 memo to Indiana Right to Life's legislative committee that the recent appointment of Kavanaugh "is not a guarantee" that Roe will be overturned and that "of the nine Supreme Court justices, only Clarence Thomas has stated in a judicial opinion that Roe v. Wade should be overturned and that a "major obstacle" is the general reluctance of the high court to overturn cases it already has decided," Yetter reports.

Bopp, in the memo, urges abortion opponents to set "realistic goals" for legislation and to avoid "problematic" legislation like the fetal heartbeat bills, which under current law is unconstitutional and if struck down comes at a high costs to states that challenge them.

That said, passing bills like those pending in Kentucky seems to be a national trend. Yetter reports that similar measures are under consideration in about half a dozen other states, even though "the Supreme Court has consistently ruled that states may not ban abortion before fetal viability, the point at which a fetus could survive outside the womb, considered to be about 24 weeks."

Yetter notes that two abortion laws in Kentucky have recently been struck down by federal judges: one that required abortion clinics to have signed agreements with a hospital and ambulance service, and another to require providers to perform an ultrasound, describe it and show it to the patient prior to an abortion. The state has appealed both of these cases.

A third case involves a 2018 law that would ban the most common type of abortion, known as "dilation and evacuation" at roughly 11 weeks of pregnancy or after. This case was heard in the U.S. District Court in Louisville last year and awaits a decision from the judge.

The fetal heartbeat bill is just one bill in a package of anti-abortion bills that the state's pro-life caucus introduced last week at a news conference.

Senate Bill 50, sponsored by Sen. Robby Mills, R-Henderson, which would require doctors to report all prescription drugs written for the purpose of abortions, passed the Senate 30-6 on Jan. 11. House Bill 5, sponsored by Rep. Melinda Prunty, R-Greenville, would ban abortion in Kentucky for women seeking to terminate a pregnancy "because of an unborn child's sex, race, color, national origin or disability." House Bill 148, sponsored by Rep. Joseph Fischer, R-Fort Thomas, would ban all abortions in Kentucky if the high court overturns Roe v. Wade.

Fischer said, "As we continue with this great battle, let us pray for Senator [Mitch] McConnell and President Trump to bolster our federal judiciary with men and women who will reverse the ruling in Roe v. Wade and restore the commonwealth's ability to end abortion in our lifetime."

Monday, January 14, 2019

Study finds that mothers who smoke during pregnancy could increase the chance that their kids will become obese

Mothers who smoke during pregnancy could increase the likelihood that their child will be obese later in life, a University of Kentucky study has found.

CBS News photo
The researchers have identified a potential cellular mechanism that connects a mother's smoking while pregnant to this increased risk, a UK news release says.

"It has been consistently shown that mothers who smoke during pregnancy confer increased risk of obesity to their baby, but the mechanisms responsible for this increased risk are not well understood," said Kevin Pearson, lead author of the study, which he said is "a first step towards defining those mechanisms with an eye toward potential interventions in the longer term."

This research offers possibilities to battle obesity in Kentucky, which ranks 43rd on a negative scale for obesity; 34.3 percent of Kentuckians are obese, compared to 31.3 percent nationally. It ranks second (among the 47 states that provided data) in the percentage of mothers who smoke during pregnancy: 19.5 percent, compared to 7.8 percent nationally, according to America's Health Rankings.

The study evaluated a total of 65 new mothers, all of which had full-term infants. About half of the new mothers reported smoking during their pregnancy.

Using tissue from the foreskin of the circumcised male infants, the researchers analyzed the cells that carry genetic information from one generation to another. Specifically, they looked at a protein called chemerin that is present in higher levels in the blood of obese people, but had not been measured in infants that had been exposed to cigarette smoking during pregnancy.

"Results showed that chemerin was more prevalent in the skin and isolated cells of infants whose mothers smoked during pregnancy, suggesting that smoking in pregnancy could be leading to changes in the regulation of the genes that play an important role in fat cell development and, by extension, obesity," says the release.

"Our work demonstrated that expectant mothers who smoke cigarettes during pregnancy induce distinct changes in chemerin gene expression in their offspring," said Pearson, who is an associate professor in the UK College of Medicine's Department of Pharmacology and Nutritional Sciences.

The researchers say the next step is to study the cells from the infant's umbilical cords to see if these findings also hold true in female infants.

It is the hope that this research could "provide a springboard for the development of effective treatments against pediatric and adult obesity in babies born to smokers as well as those exposed to other in utero environmental exposures."

Sunday, January 13, 2019

Flu numbers jumped 65% in first week of year; about half of cases are children; several months left in flu season, so get your shot

By Al Cross
Kentucky Health News

The number of influenza cases confirmed in Kentucky rose by 65 percent in the first week of 2019, adding nearly 1,000 cases for a total of 2,408 in the current flu season, according to the latest weekly surveillance report from the state Department for Public Health.

The department reported the first flu outbreak in a long-term-care facility, and for the first time reported cases in all 17 of the state's health regions. It said all but one of those regions (which it didn't specify) reported increased flu activity.


On the department's county-by-county map, the relatively small county of Monroe and the less-than-average sized county of Perry stood out. The state has confirmed 106 cases in Perry and 71 in Monroe in the last calendar quarter. Others could have similar numbers; 46 of the state's 120 counties had no cases or did not report. Those included some relatively large counties.

Anderson News Editor-Publisher Ben Carlson told Kentucky Health News in an email that his county doesn't show up on the map because most physicians (and the clinic at the local health department) "use a rapid nasal swab, which provides results in about eight minutes but are not reportable. Reportable cases are done with a nasal swab that is sent to a lab."

About half the Kentuckians who have been proven to have influenza in the current season are under 21. That underlines the importance of getting children vaccinated, because they are more vulnerable to serious complications of the flu, which include death. There is still plenty of time to get the vaccine, because flu season runs until May. It takes about two weeks to take full effect.

Andy Samberg and Sandra Oh
State officials and health advocates have made a special effort to get Kentuckians vaccinated this season, because last time around, more than 300 people in Kentucky, including five children, died as a result of the flu. The problem is national, and even the Golden Globe Awards got into the act, "with hosts Andy Samberg and Sandra Oh announcing that techs from Rite Aid would be providing flu shots to attendees. This bold move was meant to call out the vocal anti-vaccine celebrities who use their platform to expound views that are not scientifically informed," Sarah Fankhauser reports for Salon.

"Many who refuse to get the flu shot insist that they are not anti-vaxxers," writes Fankhauser, an assistant professor at Emory University in Atlanta and an expert in infectious diseases. "Yet, the arguments spouted by those who refuse to get their shot are grounded in as little scientific basis as those typically given by anti-vaxxers." Those arguments, and the facts to the contrary, include:

Every time I get the flu vaccine I get sick. "You can feel ill after getting the flu vaccine, but you didn’t get the flu from the vaccine," Fankhauser explains. "It stimulates the immune system to make the appropriate antibodies, causes a bit of inflammation and that can cause uncomfortable symptoms. Another explanation is that you actually got sick, either from the flu virus you picked up prior to getting the vaccine, or from a completely different virus altogether." The vaccine is made from dead virus, so it can't inflect you.

I never get the flu, so why should I get the vaccine? "Think about the flu vaccine like buying a lottery ticket—except that the vaccine has odds that are much, much more in your favor," Fanhkauser reports. "The less selfish response: It’s not just about you. Limiting outbreaks and reducing the number of infections benefits everyone. Think about the immunocompromised, elderly or very young. Many people in those categories cannot get the flu vaccine or have limited protection from the vaccine, and they are at greater risk for contracting the flu and for developing severe complications, including death. When everyone gets the flu vaccine, the risk to these individuals is reduced."

The shot only offers limited protection, so why get the vaccine if I’m just going to get the flu anyway? "Some people, and many who refuse to get the vaccine for this reason, have the idea that the development of the seasonal flu vaccine is haphazard. It’s not," Fankhauser writes. "There is a rigorous, methodical scientific approach to developing the vaccine every year. Unfortunately, some years the vaccine is less effective than other years. However, the vaccine will always provide some protection, which is better than none. Even in the worst years, and even with limited protection, the vaccine can help reduce the severity and duration of symptoms."

It’s so inconvenient; I have to get it every year! "It can be certainly inconvenient to schedule time to get the vaccine each year, but more inconvenient is the huge financial cost to getting the flu," Fankhauser argues. "The costs can include doctor visits, medicine and a reduced paycheck for missing work. Companies and employers have to deal with covering shifts and lost productivity when employees take a week or more off of work to recover from the flu."

Saturday, January 12, 2019

Chain that robbed Fulton of its hospital continues to abandon small towns, says it's no longer a rural hospital company

In politics, if you want to know where things are coming from and where they are headed, one maxim is to "follow the money." That could apply to the evolution of what used to be a rural hospital chain, Community Health Systems of Franklin, Tenn.

"The company has been selling off or closing poorly performing rural hospitals for the last several years," reports Blake Farmer of Nashville Public Radio. "The selling spree is primarily meant to pay down the company's outsized debt load left over from when Community Health was growing as fast as it could. But the hospital chain was also strategically pulling out of small towns."

Farmer adds, "CEO Wayne Smith told investors gathered at this week's annual J.P. Morgan Healthcare Conference in San Francisco that it's almost entirely left communities with fewer than 50,000 people — once its calling card compared to competing hospital chains." Smith said during a presentation, "We're no longer a non-urban -- or for some of you all, a rural -- hospital company."

Parkway Regional Hospital before it closed in 2015
CHS has 111 hospitals in 20 states. In once owned Parkway Regional Hospital in Fulton, Ky., but closed it in 2015, steering business to a hospital it owned in nearby Martin, Tenn. Kentucky had expanded the Medicaid program, which helped rural hospitals, and Tennessee has not, but much of the now-closed hospital's service area was in Tennessee.

"Public officials from Fulton County wanted to take over the hospital and find other providers who might continue services in the area, but CHS rejected this offer, likely, to pre-empt competition for patients in the county," said a study by the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute. "Further, CHS placed restrictions on the use of the hospital – namely, it permitted no acute-care facility to operate there, an action that one respondent said 'strangled' the community’s access to local health care services."

Friday, January 11, 2019

Bill would make Ky. 34th state to legalize medical marijuana, with lots of rules; lack of research remains obstacle for Senate leader

Lawmakers announced their introduction of a bill to legalize
marijuana for medical purposes on Jan. 9. (WDRB image)
Kentucky lawmakers have introduced a bill to legalize medical marijuana and are more hopeful about its passage than last year, despite opposition from leaders of the state Senate.

The sponsors of House Bill 136, the proposed Medicinal Cannabis Act, said at a news conference announcing the bill on Jan. 9 that it differs from previous versions that have failed "because it establishes a new, highly regulated medical marijuana industry," Lawrence Smith reports for Louisville's WDRB.

The bill would allow health-care providers to prescribe marijuana as medicine and would require licensing by the state for cultivators, dispensaries, processors, practitioners and patients. It would be regulated by the state  Department of Alcoholic Beverage Control, which would have "and Cannabis" added to its name before "Control." (Cannabis is the botanical name of the plant from which hemp and marijuana are produced.)

"Medical marijuana legalization has picked up support from some Republican Kentucky lawmakers, including Sen. Dan Seum of Bullitt County, who said he 'smoked a joint' after cancer treatment a number of years ago instead of taking opioid painkillers," Chris Kenning reports for the Louisville Courier Journal, quoting him: "And guess what? No nausea." Seum said he plans to co-sponsor a bill in the Senate similar to the House measure.
The House bill's primary sponsors are Rep. Diane St. Onge, R-Fort Wright, and Rep. Jason Nemes, R-Louisville. Nemes said he was confident that the bill would easily pass the House, but its chances in the Senateare more in doubt.

John Cheves of the Lexington Herald-Leader reports that on the day the bill was introduced, Senate President Robert Stivers made a floor speech asking for more research on medical uses of marijuana. “Where is the study?” asked Stivers, a Manchester lawyer. “Deliver me the study. An appropriate Tier 3 study with control groups that says it is medicinal or therapeutic.”

Research on the medical uses of marijuana has been largely stymied because federal law makes it a Schedule I drug, one with no recognized medical use.

Republican Rep. Danny Bentley, a pharmacist from Russell in Greenup County, has filed a resolution to ask the federal government to expedite research on medical marijuana. That would require the federal government to move marijuana to Schedule II, a list of dangerous but useful drugs.

"We need more research on the harmful effects. Benefits are modest at best; harms are unknown," Bentley told lawmakers on Dec. 12 at the interim joint health committee.

Legalizing marijuana, whether for medicinal or recreational purposes, is a topic that evokes great controversy.

Malcolm Gladwell reports in an in-depth article for The New Yorker about the research on marijuana, and comes to the conclusion that more research is needed.

He writes that the National Academy of Medicine's report that analyzed the scientific literature on cannabis, released in January 2017, "simply stated, over and over again, that a drug North Americans have become enthusiastic about remains a mystery."

Gladwell notes that whether it's pain, nausea, Tourette's syndrome, Parkinson's or anxiety, there simply isn't enough research to conclusively know if it helps or not, let alone to determine dosing, routes of administration, how it interacts with other drugs and its side effects. He adds that this lack of research is also true about the potential risks associated with its use.

Gladwell also points out that it's hard to study a substance that until recently has been largely illegal. He notes that the available studies were done in the 1980s and '90s, when the product was much less potent than much of the marijuana sold today.

The Herald-Leader editorial board, writing in support of the bill, argues that if Kentucky's lawmakers and Congress can pass a "right to try" bill to give terminally ill patients access to unproven, experimental drugs that lack U.S. Food and Drug Administration approval, "It's hypocritical then that many of the same officials, in Frankfort and Washington, still want to deny a treatment to patients who say it's the most effective relief for their chronic pain, PTSD and other symptoms -- a substance that has been used medicinally for millennia and produces none of the tragic side-effects that FDA-approved prescription opiates have inflicted on Americans."

Thirty-three states and the District of Columbia have legalized marijuana in some form for medicinal use. Another 10 have legalized recreational marijuana.

2 anti-abortion bills are already moving through the Republican-led General Assembly, and several others await action

Sen. Matt Castlen spoke at a Pro-life Caucus event in the
Capitol. (Lexington Herald-Leader photo by John Cheves)
In the first week of the 2019 legislative session, opponents of abortion began moving bills through the General Assembly.

The Senate passed a bill to require mandatory reporting of chemical abortions, and was poised to pass one that would ban abortions if a fetal heartbeat has been detected, usually about six weeks into pregnancy. The measure has received two of its required three readings and has been assigned to a committee.

The bills are part of a package of introduced Thursday by the legislature's Pro-life Caucus. Most are expected to face court challenges if they become law, because of the U.S. Supreme Court's abortion decisions. House Bill 148, sponsored by Rep. Joseph Fisher, R-Fort Thomas, would ban all abortions in Kentucky if the high court overturns the 1973 Roe v. Wade decision.

A federal court struck down two laws passed last year to restrict abortion, and a challenge to a third one is pending, John Cheves reports for the Lexington Herald-Leader. Few abortion bills passed until Republicans took control of the House in the 2016 elections.

This year's Senate Bill 9, sponsored by Sen. Matt Castlen, R-Owensboro, “is simply a bill that says if you have detection of a heartbeat, then that child is a living human being, and you can no longer murder that child in his mother’s womb,” Castlen said at a Capitol news conference Jan. 10.

Rep. Robert Goforth, R-East Bernstadt, (Laurel County) has filed a similar measure, HB 100,  Goforth is running against Gov. Matt Bevin for the Republican nomination for governor. 

Critics of the heartbeat bill say that women don't know they are pregnant until after six weeks of pregnancy, and ultrasounds that might reveal a problem in the pregnancy typically aren't done until 18 to 20 weeks of gestation, Cheves reports.

“Essentially what you’re putting in place is a six-week ban, which from our doctors’ perspective is a complete ban on abortion,” Kate Miller, advocacy director for the Kentucky ACLU, which has sued to block several past abortion laws, told Cheves. “With a six-week ban, we know nothing about the health of the pregnancy.”

Under the bill, doctors convicted of performing an abortion without first checking for a fetal heartbeat would be guilty of a Class D felony and face one to five years in prison, any abortion done because of "medical emergency" after a fetal heartbeat is detected must be documented.

Senate Bill 50, sponsored by Sen. Robby Mills, R-Henderson, would require doctors to report all prescription drugs written for the purpose of abortions, such as RU-486, to the state vital statistics office, which would be required to publish online an easily accessible annual report to show how many such prescriptions are written. The Senate passed it Jan. 11 on a 30-6 vote.

"I believe it is important to accurately report the abortions that happen in our state just as we accurately report other deaths, births and all the other vital statistics," Mills said. Describing himself as a "protector of life," he later added, "When you are taking a medicine that is terminating a life, I think that is something that needs to be reporting."

An opponent of the measure, Sen. Denise Harper Angel, D-Louisville, said "This bill is nothing more than another attempt to overturn Roe V. Wade, which 72 percent of the population doesn't want."

One other abortion bill, HB 5, would ban abortion in Kentucky for women seeking to terminate a pregnancy "because of an unborn child's sex, race, color, national origin or disability, except in the case of a medical emergency." Violation would be a felony punishable by up to five years in prison. A similar bill was filed last year, but did not make it out of committee. This one is sponsored by Rep. Melinda Prunty, R-Greenville.

Deborah Yetter of the Courier Journal reports in some detail about the two state abortion laws that were recently struck down by federal judges: an old one that required abortion clinics to have signed agreements with a hospital and ambulance service, and a recent one to require providers to perform an ultrasound, describe it and show it to the patient prior to an abortion.

A third case involves a 2018 law that would ban the most common type of abortion, known as "dilation and evacuation" at roughly 11 weeks of pregnancy or after. This case was heard in the U.S. District Court in Louisville last year and awaits a decision from the judge.

Thursday, January 10, 2019

2/3 of registered voters in Ky. poll on Medicaid oppose Bevin's changes, as simply described; not asked about work requirement

By Melissa Patrick
Kentucky Health News

A poll conducted for a group opposing Gov. Matt Bevin's coming changes to the Medicaid program shows that two-thirds of Kentucky voters oppose the changes generally, and specifically oppose cutting back coverage of dental and vision care and non-emergency transportation services.

InsureKY, which released the poll, is a statewide coalition of nonprofits "formed to promote more affordable health insurance, better care, and stronger consumer protections for all Kentuckians," according to the release. The Kentucky Equal Justice Center, a member of the coalition, paid for the two questions in the Mason-Dixon Polling & Research survey, taken Dec. 12-15.

The first question offered respondents a very simple description of the plan and one of its effects: "Federal officials recently approved Governor Matt Bevin's 'waiver' that will change Kentucky’s Medicaid plan and reduce the number of people who receive benefits." The last statement is based on the state's estimate that after five years the program will have 95,000 fewer beneficaries than it would have without the changes. (Tens of thousands of Kentuckians go on and off Medicaid each month.)

After the simple descriptions, the poll asked, "Do you feel the Medicaid program in Kentucky should be scaled back or do you feel the Medicaid program in Kentucky should be left as it is?" Sixty-six percent said the program should be left as it is, 25 percent said it should be scaled back, and 9 percent said they weren't sure.

Most registered voters in each of the state's five regions said they wanted the program to be left alone, with the highest share in Louisville, 70 percent, and the lowest in Northern Kentucky, 59 percent.

There was a difference among political affiliation, with 77 percent of Democrats, 64 percent of independents and 53 percent of Republicans saying they opposed the changes.

At 33 percent, Republican voters had the highest percentage saying they wanted the program scaled back, followed by independents at 28 percent and 19 percent of Democrats.

The second question asked: "Another change Governor Bevin is making to Medicaid is to remove dental, vision, and non-emergency medical transportation coverage for nearly half a million adults. Instead, these adults would have to earn dental and vision services by completing healthy activities. Do you support or oppose the Governor’s plan to reduce benefits in this way?"

InsureKY graph
The poll found that 65 percent of registered voters opposed these changes, 28 percent supported them and 7 percent were undecided.

The poll did not ask about the plan's work requirements, which may be more popular.

If courts approve, the plan would require most "able-bodied" beneficiaires of the program's 2014 expansion to work, attend school or participate in certain activities 80 hours a month to keep their health insurance.

The plan also includes premiums, small deductibles or co-payments, strict reporting requirements and lock-outs for non-compliance. It is tentatively set to start April 1, with the work and community engagement options to be phased in regionally.

The plan largely applies to the nearly 500,000 Kentuckians who have gained coverage through expansion of the program to those who earn up to 138 percent of the federal poverty line ($16,753 for an individual). Kentucky has about 1.4 million people on Medicaid, but only 165,000 are expected to come under the work and community engagement requirements.

The new plan was set to roll out July 1, but a federal judge vacated federal approval of it June 29 and sent it back to the Department of Health and Human Services for review, ruling that federal officials had not fully considered the projection of 95,000 fewer people on the Medicaid rolls.

Opponents of the plan have said these new rules and strict reporting requirements will result in fewer Kentuckians having access to health care, often noting the 17,000 people in Arkansas who have lost their Medicaid coverage since June because they did not meet their state's new work and community engagement requirements.

The Bevin administration has said the new plan isn't set up to kick people off of the program, but to help them become more engaged in their health care and to help them move to jobs that offer private insurance.

HHS re-approved the plan in November, but more litigation is likely.

Cara Stewart, an attorney with the Kentucky Equal Justice Center, one of the three organizations that filed the original lawsuit on behalf of 16 Kentucky Medicaid recipients, said they will file their amended complaint Monday, Jan. 14, the last day allowed on the judge's briefing schedule. The state will need to file any opposition to the motion and its reply by Feb. 11.

Less vulnerable to the court challenge is the change that will require people who gained coverage through Medicaid expansion to earn dental and vision care by participating in self-improvement activities, such as passing a GED exam or completing a stop-smoking class. These services have been offered for free.

The new plan also completely removes non-emergency medical transportation services and offers no provision for regaining them.

Opposition to these changes also varied among political parties, with 79 percent of Democrats, 62 percent of independents and 49 percent of Republicans opposing them.

“These results are a strong statement. The policy changes being proposed simply do not align with public sentiment or the realities that low-income Kentuckians face,” Sheila Schuster, executive director of the Advocacy Action Network, said in the release.

The poll surveyed a total of 625 registered Kentucky voters via both land-line and cell-phone numbers. The margin of error in any statewide figure is is plus or minus 4 percentage points, and higher for the regional, partisan and demographic groups.

After state cigarette tax rose 50 cents, half of Kentucky's adult smokers cut back, considered quitting or tried to quit, poll finds

By Al Cross
Kentucky Health News

Half of Kentucky's adult smokers say they smoked less, or considered or tried to quit smoking, following the increase in the state's cigarette tax on July 1.

That's according to the latest Kentucky Health Issues Poll, taken Aug. 26 through Oct. 21, in approximately the third and fourth months after the tax rose to $1.10 a pack from 60 cents.

"The cigarette tax increase is changing thinking and behavior about smoking in Kentucky," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll.

The poll found that 39 percent of Kentucky smokers reduced the number of cigarettes they smoked, 33 percent considered quitting, and 26 percent actually tried to quit.

The poll did not ask them if their efforts to quit had succeeded, because “It typically takes several attempts to quit,” said Bonnie Hackbarth, the foundation's vice president for external affairs.


While many tried to reduce their smoking, "Cutting back the number of cigarettes smoked per day . . . is not an effective strategy for quitting," said Ellen Hahn, a University of Kentucky nursing professor and a leading tobacco-treatment advocate. "Even low levels of smoking increase heart disease risk. Reduction in the number of cigarettes does not totally eliminate health risks."

The poll is an annual telephone survey of Kentucky adults, co-funded by Interact for Health, a Cincinnati-area health foundation. It found that Kentucky adults' use of tobacco cigarettes and electronic cigarettes remain much higher in Kentucky than the national average.

Nearly one in four (23 percent) of Kentucky adults smoke, according to the poll. The highest rates are among lower-income adults; 35 percent of those eligible for Medicaid (earning up to 138 percent of the amount the federal government considers poverty) said they currently smoked cigarettes. Among those with higher incomes, the rate was 16 percent. The national rate is 17 percent.

Chandler chairs the Coalition for a Smoke-Free Tomorrow, a group of 180 Kentucky businesses, advocacy groups, health-care companies and other organizations working to improve health by reducing tobacco use and secondhand smoke exposure in Kentucky. The Coalition led the campaign during the 2018 legislative session to increase the cigarette tax by $1 per pack.

"We knew we wouldn't get all the health benefits we sought when the legislature opted for 50 cents instead of a dollar and decided to exempt e-cigarettes completely, but we hoped it would have some positive effect. . . . This poll shows it did," Chandler said.

In lobbying the legislature, the coalition argued that tobacco companies would counter it with consumer coupons and retailer discounts so the effective price would rise more gradually, providing less incentive to quit. The largest tobacco-cigarette manufacturer, Altria Group, seemed willing to accept a 50-cent hike, but successfully opposed a 15 percent tax in electronic cigarettes. Now Altria is buying 35 percent of Juul, by far the leading maker of e-cigarettes,

Chandler said the coalition has "amped up our efforts to encourage Kentuckians to quit, and we'll keep on advocating for policies and funding to help them do just that. Meanwhile, congratulations to those who have taken the opportunity to quit. Quitting smoking is one of the most beneficial steps individuals can take to improve their own health, and reducing tobacco use is the single most impactful thing the Foundation for a Healthy Kentucky can do to improve health in the commonwealth."

For information and assistance in quitting smoking, call 1-800-QUIT-NOW or visit https://quitnowkentucky.org.

Monday, January 7, 2019

UK professor who won whistleblower settlement for loss of post-retirement job returns to run an oral health program for 18 months

Raynor Mullins
When he retired from the University of Kentucky dental school several years ago, Raynor Mullins, now 74, continued working for UK on efforts to improve oral health in the state, especially in rural areas.

When he lost that job, he alleged in a lawsuit that it was retribution for his criticism of Gov. Matt Bevin's removal of dental care as a basic benefit for the working poor in Medicaid. Last month, as the case was about to go to trial, the university agreed to pay him $620,000 and rehire him.

His new job will be director of a new Oral Health Innovation Initiative in the College of Public Health, with the first big goal developing a strategic plan for the initiative. It will receive $100,000 in start-up funding and "Mullins will be paid $52,800 for working 40 percent of a full-time job" for 18 months, and hold the rank of professor, Linda Blackford reports for the Lexington Herald-Leader.

His attorney, Joe Childers, told Blackford, “Dr. Mullins is excited to lead this new Oral Health Innovation Initiative, and believes it will lead to long-term gains for the health of Kentuckians. It is truly a win-win for both Dr. Mullins and the University of Kentucky.”

In settling the lawsuit, "UK did not admit that College of Dentistry Dean Stephanos Kyrkanides had pushed Mullins out for his comments, despite numerous depositions from witnesses who heard Kyrkanides say that Mullins had to go," Blackford notes. "In agreeing to allow the lawsuit to go to trial, U.S. District Judge Robert Weir called the case 'the epic story of academic intrigue and the place of free speech.'" Mullins' post-retirement job did not have traditional tenure protection.

In his lawsuit, Mullins said Kyrkanides had told him that he needed to stay "off radio" on the matter, and "communicated that this direction came from 'up top'." The first named defendant in the suit was Mark Birdwhistell, the UK HealthCare vice president and former state Medicaid director who helped Bevin's staff draft the proposed changes. Mullins claimed Kyrkanides was acting at the direction of Birdwhistell, who was acting at the behest of Bevin or his agents. The other defendant was "John Doe," identified only as a member of the governor's administration. They were dismissed from the case several months ago, after Mullins amended his complaint to exclude them. Bevin's office denied any interference, and Birdwhistell testified in a deposition that he had no discussions with anyone in Frankfort about Mullins' comments and never discussed Mullins with Kyrkanides (who testified likewise).