Friday, July 1, 2016

Judge rejects Bevin lawsuit against Louisville abortion clinic; administration says it will appeal

Republican Gov. Matt Bevin has lost the first round in his legal fight against the new but not formally licensed Planned Parenthood abortion clinic in downtown Louisville.

Circuit Judge Mitch Perry found that Planned Parenthood of Indiana and Kentucky "had, as it had claimed, been following directions of state officials when it began offering abortions in December as part of its effort to obtain a state license," Deborah Yetter reports for The Courier-Journal.

The directions came as Bevin's Democratic predecessor, Steve Beshear, was preparing to leave office. Bevin's lawsuit contends that any pre-license authorization was contrary to law, that the facility's patient-transfer agreements with other health-care facilities were a sham, that six abortions were performed before the authorization was given Dec. 7, and that Planned Parenthood was "attempting to accelerate the process" before Bevin took office in the first minutes of Dec. 8.

"Perry found no evidence Planned Parenthood had willfully violated the law during the licensing process," Yetter reports. "Rather, the judge found that cabinet officials, prior to the Bevin administration, had followed 20 years of consistent application of the law and state regulations involving abortion clinics. Perry said it 'defies reason' to conclude Planned Parenthood willfully violated the law."

Bevin spokeswoman Amanda Stamper said the state will appeal. The lawsuit seeks fines of $684,000, based on state law allowing a fine of up to $10,000 for each violation and $1,000 a day for continuing violations.

Perry's ruling doesn't mean Planned Parenthood "can resume offering abortions immediately," Yetter notes. "It must first obtain a license from the Bevin administration's Cabinet for Health and Family Services. And it suffered a setback in that effort in March when KentuckyOne Health backed out of an agreement required as part of a license to provide hospital care in the event of an emergency." Planned Parenthood said KentuckyOne CEO Ruth Brinkley cited "incredible" outside pressure as the reason. Planned Parenthood has submitted new transfer agreements to the cabinet, said its attorney, Thomas Clay.

Several Kentucky school districts are requiring students who drive to school to pass a drug test; Hardin County is the latest

Image: commons.wikimedia.org
By Melissa Patrick
Kentucky Health News

Hardin County has joined a growing number of Kentucky school districts that require student drivers, and those who participate in athletics, to submit to random drug testing, Anna Taylor reports for the News-Enterprise in Elizabethtown.

“We have traditionally done random drug testing with our athletes; however, it is a privilege to provide transportation services to our students,” Supt. Nan­nette Johnston told Taylor. “For the safety of our students that are driving and all students and everyone else on the road, we want to make sure they are safe as well. They will submit to the same random drug testing that happens with our athletes.”

The policy was recently adopted by the county school board and is slated to take affect in August at North Hardin, Central Hardin and John Hardin high schools. It says that if a student fails a urine test, driving privileges on school property will be suspended for 12 weeks and their parents will be notified. They will be tested again after the 12 weeks; they can regain their driving privileges, or, if they have a second offense, their privileges will be suspended for the rest of the school year. Refusal to cooperate results in suspension for the year.

“We want to make sure they haven’t been using and they don’t have anything in their vehicles that’s tempting them or other students,” Johnston said. “When they choose to be like an adult, they’re going to be treated like an adult.”

A quick internet search found that drug-testing student drivers, along with student athletes, seems to have become a trend across the state, with Whitley, Mercer, Hancock, and Bell counties all popping up with similar policies.

Private schools in Kentucky have also adopted the policy. Trinity High School in Louisville began its random drug and alcohol screening this year, but its policy includes all students, not just drivers Toni Konz reported for WDRB-TV. Covington Catholic High School will do random drug testing, including student drivers, next year, Desire Thompson reported for VIBE.

Last year, Andrew Wolfson of The Courier-Journal did an in-depth story about the legalities of random drug testing in schools, reporting that while the U.S. Supreme Court has never ruled on whether public schools could do random drug screenings on all students, it is not likely to approve such a rule.

In an updated statement in March 2015, the American Academy of Pediatrics said it did not support such policies. It said that while it supports the efforts to identify and address student substance abuse, tests can have false positive results, and such policies erode the student-school relationship and create issues about confidentiality of students' medical records.

Despite Bevin's take-it-or-leave it statements, officials say negotiations continue with feds on proposed Medicaid changes

Gov. Matt Bevin said when he announced his plan to change Medicaid that if the federal government didn't approve it, he would end the eligibility expansion that has added more than 440,000 people to the program. But his lieutenants say the proposed waiver of normal Medicaid rules is still being negotiated with federal officials.

"We're continuing to negotiate in good faith. We're pretty confident they'll approve our waiver or something pretty close to it," Adam Meier, Bevin's deputy chief of staff, said at a forum hosted by the Health Enterprises Network, a Louisville health-business group, Deborah Yetter reports for The Courier-Journal.

The architect of the plan, University of Kentucky health Vice President Mark D. Birdwhistell, said likewise. "It is not an all-or-nothing transaction,” Birdwhistell told Kentucky Health News Editor and Publisher Al Cross for his fortnightly C-J column. "There’s negotiation on pieces and parts and components within the various waivers, and I expect that same negotiation to take place here as well."

Birdwhistell told Cross that the stickiest point is likely to be its requirement that able-bodied adults who aren’t the primary caregiver of a dependent have a job, look for one, take job training or do volunteer work. The Department for Health and Human Services has never approved a work requirement, and said in response to Bevin's June 22 announcement, “States may not limit access to coverage or benefits by conditioning Medicaid eligibility on work or other activities.”

Birdwhistell "wouldn’t speculate about how that might be negotiated, but the structure of the plan strongly suggests that one solution would be to make work-oriented activities part of the plan’s rewards system – in which Medicaid enrollees can earn better benefits (including vision and dental, which the plan would remove from the program’s basic benefits)," Cross writes. "Bevin could declare victory, and so could President Obama, who counts health reform as his main accomplishment."

Cross noted criticism from Democratic U.S. Rep. John Yarmuth of Louisville, in an interview with Nick Storm of cn|2’s “Pure Politics.”

“He just wants to blame the Obama administration for ‘forcing him’ to roll back the Medicaid expansion,” Yarmuth said of Bevin, a Republican. “This is a way to do it with less political pushback. I hope that people in Kentucky figure out what he’s doing and don’t let him get away with it ... a very cynical approach to doing business.”

Cross suggested that Bevin could avoid much of the pushback if he dragged out the negotiations "past the Nov. 8 election, in which Republicans have a good chance to gain control of the state House and thus full control of the General Assembly. That power struggle means a lot to Kentucky, but probably little to the White House. And it probably means little to the 400,000-plus Kentuckians whose health care is at risk. But they have the most at stake."

State honors three local groups for fighting abuse of elderly

Three community groups have received awards from the Kentucky Cabinet for Health and Family Services to help their efforts to stop elder abuse.

The Public Awareness Initiative awards, including $500 each, went to the Kentucky River Council Against the Maltreatment of Elders, the Northern Kentucky Elder Maltreatment Alliance and the Pulaski County Elder Abuse Council.

Such efforts make a difference for Kentucky’s seniors, said Judge Timothy Feeley, deputy secretary of the cabinet. “Elder abuse and neglect has risen to such a level of concern that these councils have become crucial resources for local education and prevention,” he said. “Through their resourcefulness and collaborations, their projects are teaching respect for elders and saving lives. I commend their community efforts over the past year.”

Kentucky River CAME operates in Breathitt, Knott, Lee, Leslie, Letcher, Owsley, Perry and Wolfe counties. In the past year, CAME has hosted a Senior Safety and Advocacy Day, sponsored a children’s poster contest and held its second Regional Elder Abuse Awareness Day, drawing about 300 people, dressed in elder abuse prevention T-shirts.

Another popular project was “Blowing Bubbles for Elder Abuse.” On May 4, CAME distributed small bottles of bubbles to elementary schools and senior centers in all eight counties. Students and seniors all blew bubbles to raise awareness of elder abuse prevention and encourage respect for elders.

Northern Kentucky EMA, serving Boone, Campbell, Gallatin, Kenton, Owen and Pendleton counties, presented workshops on insurance fraud and scams, reverse-mortgage myths and helping the rural elderly with utility bills; sponsored its annual children’s poster contest with the theme “Why I Love My Grandparents;” and circulated fliers and training materials about reporting procedures, types of abuse and how to avoid abuse.

In its nomination materials, the Pulaski County Elder Abuse Council called itself “small but mighty.” 
About 100 people attended its annual conference last August, which featured speakers on law enforcement, the legal system, hospice care, health care and the state’s adult safety program. The council raised awareness and more than $200 through its Pumpkins on Main decorating project and provided 12 needy seniors with clothes and food at Christmas.

Kentucky received more than 30,000 calls to report abuse, neglect and exploitation of people age 60 and older for state fiscal year 2015. State law requires reporting suspected abuse, neglect or exploitation is the law, and it’s confidential. The toll-free reporting hotline is 1-877-KYSAFE1 (1-877-597-2331).

Every county has a similar council. Membership is free and open to anyone interested in working to prevent elder abuse in his or her community. To become involved contact state liaison Stacy Carey at 502-564-7043. Get more information about the councils and recognizing the signs of elder abuse online at chfs.ky.gov/dcbs/dpp/eaa/.

Signs of Elder Abuse
If you believe there is imminent risk, immediately call 911 or local law enforcement.

Neglect
§  Obvious malnutrition, dehydration
§  Dirty and uncombed hair; dirty and torn or climate-inappropriate clothes; or offensive body odor
§  Hoarding
§  Lack of glasses, dentures or hearing aid, or lack of medical care
§  Bedsores
§  Recent suffering or loss of spouse, family members or close friends

Physical Abuse
§  Frequent injuries such as bruises, burns, broken bones; explanation of the injury seems unrealistic
§  Multiple bruises in various stages of healing, particularly bruises on inner arms or thighs
§  Experiences pain when touched
§  Loss of bowel and bladder control
§  Never leaves the house or allows visitors
§  Never mentions family or friends

Sexual Abuse
§  Evidence of sexually transmitted disease
§  Irritation or injuries to the mouth, genitals or anus
§  Upset when changed or bathed
§  Fearful of a particular person
§  Loss of bowel and bladder control

Emotional/Psychological Abuse
§  Isolated from family and friends
§  Sudden dramatic change in behavior, appearing withdrawn, depressed, hesitant to talk openly
§  Caregiver won’t let victim speak for herself or himself
§  Caregiver scolds, insults, threatens victim
§  Trembling, clinging

Financial Abuse
§  Unusual activity in bank account; sudden large withdrawals, expenditures that are not consistent with past financial history
§  Use of automated teller machines (ATM) when the person has no history of using ATMs or cannot walk
§  A recent will, when the person seems incapable of writing a will
§  Rights signed away on legal papers without understanding what the papers mean
§  Unpaid bills, such as house payment, rent, taxes or utilities

Congress goes home for July 4 after another Zika impasse

Congress took a break for the July 4 holiday after reaching another impasse on funding to combat the Zika virus that has caused birth defects in Mexico and the Caribbean.

"Senate Democrats on Tuesday shot down a House-passed bill that would have provided $1.1 billion to fight the mosquito-borne virus, citing opposition to the measure's changes in pesticide regulations and restrictions on money for birth control," Fox News reports. The bill would also "rob Obamacare of funding, impose new restrictions on Planned Parenthood and provide some $800 million less than the Obama administration is seeking," Politico reports, and "allow the Confederate flag to fly at veterans' cemeteries."

"In the short term, Democrats are more open to criticism: After clamoring for new Zika funding for months, they are set to vote against a bill at funding levels they’ve already agreed to," Politico notes. "But given the history on legislative impasses, Democrats are betting that the majority party will be held responsible by voters."

Republicans remained firm. Senate Majority Leader Mitch McConnell of Kentucky "suggested that, barring a sudden deal, there may be no vote until the upper chamber returns in September."

Senate Democratic Leader Harry Reid of Nevada "pressed for negotiations to resume and bemoaned that both parties agreed in May to a $1.1 billion Zika bill, only for House Speaker Paul Ryan to make changes," Fox reports. "Reid argues those changes appeased the chamber’s conservative conference, but resulted in an unacceptable piece of legislation."

President Obama asked for $1.9 billion for Zika in February. "The Republicans controlling Congress instead forced the administration to redirect more than $500 million in unspent Ebola-fighting funds to combat Zika," Fox notes. After the House passed a bill with less than a third of the money Obama wanted, Republicans in the House and Senate agreed on a $1.1 billion plan with the added provisions and spending cuts to pay for it.

"Democrats particularly opposed a provision that restricts the use of $95 million worth of federal grants to provide services such as birth control to women in Puerto Rico threatened by the virus. Democrats charged that the restrictions were targeted at clinic on the island run by Planned Parenthood, a group loathed by many anti-abortion Republicans," Fox reports. "In addition to the limits on Planned Parenthood, the bill would temporarily lift Clean Water Act permitting requirements on pesticide spraying for municipalities and other large-scale users."

A lobbyist for the March of Dimes, which advocates for maternal and fetal health, told Politico that the Republican bill was “doomed from the start.” Cindy Pellegrini continued, “We have a hard time imagining an issue that could be more of an emergency than an infectious disease transmitted by mosquitoes that destroys babies’ brains in utero. The package looked like it was not designed to be successful and that was deeply troubling for us.”

Obama said Friday that a Zika vaccine could be developed in "fairly short order" once Congress enacts the funding. University of Kentucky researchers are among those working on that.

Ky. and Southeast lack statewide smoking bans; political climate here has shifted focus to local bans; Hazard just passed one

By Melissa Patrick
Kentucky Health News

Kentucky hasn't passed a comprehensive smoke-free law, but neither has any state in the Southeast, notes a recent Centers for Disease Control and Prevention report.

The CDC report says 28 states have comprehensive smoke-free laws, which are laws that prohibit smoking in all indoor areas of workplaces, restaurants and bars. These bans cover about 60 percent of Americans.

California was recently added to the list, but overall adoption of statewide smoking bans has slowed recently. All but two of the 28 states, including the District of Columbia, enacted their comprehensive smoke-free laws between 2000 and 2010, and only two states passed such laws between 2010 and 2016. (Seven states have laws that include electronic cigarettes.)

"We've made great progress in protecting many Americans from secondhand smoke exposure," CDC Director Tom Frieden told HealthDay. "But millions of Americans, especially those living in southeastern states, are still unprotected from this completely preventable health hazard."

The report marks the 10-year anniversary of the 2006 Surgeon General's report, The Health Consequences of Involuntary Exposure to Tobacco Smoke, that says there is no such thing as risk-free secondhand smoke and the only way to protect against it is by completely eliminating indoor smoking.

Exposure to second-hand smoke can cause stroke, lung cancer and heart disease in adults. Exposed children are at an increased risk for sudden infant death syndrome, acute respiratory infections, ear infections, asthma and slowed lung growth.

"Secondhand smoke exposure contributes to approximately 41,000 deaths among nonsmoking adults and 400 deaths in infants each year," says the report.

The most recent Kentucky Health Issues Poll found that 66 percent of Kentucky adults favor a statewide smoking ban and 31 percent opposed it. However, efforts for a ban have stalled because new Republican Gov. Matt Bevin opposes such legislation, saying ity should be a local decision.

About one-third of Kentucky's population is covered by comprehensive smoke-free policies, and another 10 percent or so live in places that have ordinances with varying exceptions. Kentucky has one of the nation's highest smoking rates, 26 percent.

Ellen Hahn, a University of Kentucky nursing professor and director of the smoke-free policy center, encouraged advocates at a recent smoke-free conference to shift their efforts to localities because of the current political climate.

Hazard just approved an indoor workplace smoking ban that goes into effect July 6, WYMT-TV reports. In Eastern Kentucky, smoking and lung cancer rates are double the national average, PBS NewsHour reports.

Of the 23 states without comprehensive smoke-free laws, 14 of them have some local comprehensive smoke-free laws and nine of them don't have any such laws at either the local or state level. Eight of those nine states without smoking bans have statutes that prohibit local bans, says the report. One, North Carolina, bans smoking in bars and restaurants.

"Smoke-free laws provide a low-cost, high-impact benefit to the public's health," Corinne Graffunder, director of the CDC's Office on Smoking and Health, told HealthDay. "These laws substantially improve indoor air quality, help smokers quit, prevent youth and young adults from starting to smoke, change social norms about the acceptability of smoking, and reduce heart attack and asthma hospitalizations among non-smokers."


Thursday, June 30, 2016

Louisville surgeon Hiram Polk named state health commissioner

Dr. Hiram Polk
Dr. Hiram Polk, a prominent surgeon from Louisville, has been appointed as the commissioner for the state Department for Public Health.

Polk is a graduate of Harvard Medical School and received his surgical training at Washington University in St. Louis. He was a fellow at the Lister Institute of Preventive Medicine in London and the Pasteur Institute in Paris. He served as an endowed professor and chairman of the Department of Surgery at the University of Louisville from 1971 to 2005, where he trained more than 330 surgical residents. He is a native of Jackson, Miss.

Polk is a director of the Grayson-Jockey Club Research Foundation, which funds research on horses, and the Biomedical Research Foundation, which funds research on veterans' health.

“Many health issues plague the commonwealth, from chronic diseases such as heart disease and diabetes, to the serious substance abuse and addiction crisis, especially in pregnant women,” Polk said in a state news release. “Meanwhile, we must be vigilant and prepared to respond to emerging public health issues such as the Zika virus or a potential hepatitis C outbreak from intravenous drug use. I am excited to take on the role of public health commissioner because it gives me an opportunity to direct policy and implement pilot programs to address these very serious issues.”

Medicaid hearings in Bowling Green and Frankfort elicit nearly incessant criticism; third and final hearing in Hazard next Wed.

Supporters of the current Medicaid expansion sat on the front row of a packed hearing room in Frankfort.
By Al Cross
Kentucky Health News

Supporters were few and far between at the first two public hearings on Gov. Matt Bevin's plan for changes in the Medicaid program.

In Bowling Green on Tuesday and in Frankfort on Wednesday, critics of the plan said it would put too many obstacles between the poor and health care. A third and final hearing will be held in Hazard next Wednesday.

"What you're proposing to do here is more cumbersome than average folks find the insurance process now," said A.J. Jones of Louisville, identifying himself as a former Medicaid enrollee now on private insurance. He said in Frankfort that fiscal responsibility, a stated reason for the plan, is "important, but not when you're talking about people's health."

The plan would require enrollees to pay premiums of $1 to $15 a month, based on income. It would also require able-bodied adults without jobs to take job training or counseling, or do community service for nonprofit organizations.

Miranda Brown of Lexington, who helps the poor navigate the health-insurance system, said a homeless person she helped get on Medicaid told her that she would probably drop out of the program if she had to pay premiums.

Bevin and other Republicans say Medicaid enrollees need to have "skin in the game," but Harriet Seiler of Louisville said, "It's a concept that will scrape a pound of flesh from Kentuckians. . . . The sick, the poor and the unemployed are not naughty children who need to be incentivized, scolded or humiliated."

K.J. Owens of Louisville won applause from the overflow crowd in Frankfort when he said the plan "seems motivated by the concern that poor people are defective morally . . . that poor people just aren't trying hard enough. The people on Medicaid are in no more need of moral guidance than the governor and the people on the governor's staff."

Emotions peaked when Molly Shaw of Louisvile-based Parents for Social Justice predicted, "More people will be sick and more people will die. This waiver will kill people."

The plan is a request to the federal government for a waiver of normal Medicaid rules. Asked afterward to reply to Shaw's comment, Health Secretary Vickie Glisson said, "We're trying to maintain the expansion."

Bevin has said if federal officials don't approve his plan, he would end the expansion of Medicaid under federal health reform by his predecessor, Democrat Steve Beshear, that added to the rolls more than 400,000 Kentuckians earning up to 138 percent of the federal poverty level.

Emily Parento, who was Beshear's chief health-policy adviser, predicted that federal officials would not approve the work-oriented requirements or the plan's increase in premiums for enrollees between 100 and 138 percent of the poverty line. "This amounts to a penalty for poverty," she said, adding that the plan has "minimal detail" on the projected cost savings, other than reduced enrollment.

The only unequivocal endorsements of the whole plan, other than written statements from Republican legislators, came from the Kentucky Hospital Association and the state's largest hospital system, Baptist Health. KHA official Nancy Galvagni said the plan improves on those in other states "by using more carrots than sticks" to influence enrollees' behavior, and "does inject some personal responsibility into the system."

In Bowling Green, Diane Amos said her elderly mother couldn't
afford premiums. (Daily News photo by Miranda Pederson)
In Bowling Green, "A few speakers expressed support for smoking cessation programs or a pilot substance abuse treatment plan included in the proposal. But most of the about 20 people who spoke appeared passionately opposed to the changes, with comments that prompted frequent applause from the about 60 people at the hearing," reports Deborah Yetter of The Courier-Journal.

"Cara Stewart, a legal-aid lawyer who represents people on Medicaid, said Bevin’s application for a waiver conflicts with the federal government’s requirements for waivers," Yetter reports. "The goal generally, she said, is to enhance or expand coverage." Stewart said, “I don’t see anywhere in here where we’re increasing coverage I only see cuts in service and taking away access to care.”

The Frankfort hearing was part of a meeting of the state advisory council for Medicaid, chaired by nurse practitioner Elizabeth Partin of Columbia. She was among the speakers who questioned the removal of annual vision and dental exams from regular Medicaid coverage. "That's how you catch problems before they become huge problems," she said. Given the small cost, "It's not gonna break the bank either way, and it may help improve people's health."

The issue was also big in Bowling Green. “We’re No. 1 in toothlessness; so we’re not going to provide dental care for those who need it the most?” asked Chris Keyser, executive director of Fairview Community Health Center.

Franklin optometrist Steve Compton said optometrists often are the first to identify other health problems, such as high blood pressure or diabetes, during a routine eye exam. In Frankfort, Richmond optometrist Matt Burchett said optometrists discovered 15 percent of diabetics insured by United Health.

Under the plan, enrollees could earn coverage for vision and dental exams, as well as non-prescription drugs and gym-membership subsidies, by enrolling in job training, volunteer work or health-related classes.

Speakers at both hearings questioned the proposed six-month suspension of enrollment for failure to pay premiums. "It seems rather harsh," said council member Barry Whaley of Louisville, executive director of Community Employment Inc.

Bevin's deputy chief of staff, Adam Meier, noted that suspended enrollees could re-enroll sooner by paying premiums and taking a health-literacy or financial-literacy course. "We want to mirror commercial insurance coverage," he said, "to teach people how to be engaged in their health insurance plan."

Wednesday, June 29, 2016

Insurance firm's study found Kentucky's costs for long-term, in-home care dropped this year, even as nation saw an increase

By Melissa Patrick
Kentucky Health News

The cost of in-home, long-term care in Kentucky is less than it was a year ago, an insurance company study says. That should come as good news to Kentucky seniors, who are some of the unhealthiest in the nation.

"Although home-care costs are much less expensive than those in facility-based settings, the costs can add up to as much as $42,900 per year in Kentucky, which is why it's imperative for consumers to begin planning now for how they will pay for that care should they need it," Tom McInerney, president and CEO of Genworth, the company that conducted the study, said in the a news release.

McInerney said 70 percent of Americans over age 65 will need some form of long-term care and support during their lives.

Genworth's 13th annual Cost of Care Study found a cost decrease in most of the in-home care categories measured in Kentucky, with the only increase found in adult day services, which were up 2.9 percent. Nationally, cost for long-term in-home care increased.

Homemaker services, which cost an average of $3,432 a month in Kentucky, showed the largest decrease: 5 percent. There was a 4 percent cost drop in private nursing home care, which runs about $7,000 per month.

The state also showed decreases in cost for home health aides (down 2.3 percent), assisted living (1.5 percent) and semi-private nursing homes (1 percent).

In addition, the report broke down cost trends in the state's major metropolitan areas.

For example, the cost of private nursing-home care is about 10 percent less in Bowling Green than the national average, at $6,905 per month; and homemaker services in Lexington are about 8 percent less than the national average, at $3,527 per month.

The latest study gathered data from more than 15,000 long-term care providers nationwide and includes 440 regions, including all metropolitan statistical areas. It was conducted in January and February.

As cost for long-term care services rise, it is important for consumers to plan ahead, Genworth said.

Options for paying for long-term care include self-funding, government assistance and long-term-care insurance.

Genworth says you need to start saving early if you plan to self-fund. "Saving for long term care on your own can be difficult and take years to accumulate funds," says the release.

Government assistance options include Medicare and Medicaid. "Medicare pays for long-term care if you require skilled services or rehabilitative care such as in a nursing home (max. 100 days) and at home if you are also receiving skilled home health or other skilled in-home services (provided for a short period of time)," says the release. Visit longtermcare.gov for more information.

"Medicaid covers a large share of long-term care services, but to qualify your income must be below a certain level and you must meet minimum state eligibility requirements and be in a Medicaid-approved facility," says the release. Visit Medicaid.gov for more information.

The other option is long-term care insurance, which provides a "guaranteed lifetime source of income" to pay for long-term care and other expenses, says the release.

The National Association of Area Agencies on Aging is another resource to learn about long-term care and other aging issues.

Campaign seeks to build support for, and action to make, Kentucky communities more walkable for better community health

Seventy Kentucky school districts, local governments, health departments, businesses and other organizations have joined the Step It Up, Kentucky! campaign to encourage walking and build the demand for walkable communities as a way to better health.

Public-health experts recommend 30 minutes of physical activity five days a week to improve health, which can easily be achieved by walking. People are more likely to make the decision to walk when they have places, programs and policies that provide opportunities and encouragement, says a news release from the state Cabinet for Health and Family Services.

“Getting people to move more starts with improving the places we live, learn, work and play,” Obesity Prevention Program Coordinator Elaine Russell said in the release. “Communities can be built for people to be active in their everyday life. By providing safe, attractive and convenient places to walk, anybody can incorporate exercise into their daily routine.”

Step It Up, Kentucky! represents the state's response to the U.S. surgeon general’s recent Call to Action to Promote Walking and Walkable Communities, which calls on Americans to increase walking by designing communities that encourage physical activity in order to address rising rates of chronic disease.

From adding sidewalks to developing parks and recreation sites, there are a number of things communities can do to become more walkable. Winchester created a mile-long circular path in the middle of town simply by mowing a stretch of undeveloped land. Rockcastle County paved a one-mile path along a roadway in Mount Vernon, now used by walkers, runners and bikers. The path also served as the site for an eight-week walking challenge in the community. 

“Creating a culture that supports healthy lifestyles starts with building support at the local level,” said Dr. Connie White, acting commissioner of the state Department of Public Health. “All Kentuckians deserve safe, inviting places to be active.”

For more information on Step It Up!, visit the Partnership for a Fit Kentucky’s website: fitky.org/our-efforts/physical-activity/step-it-up-kentucky.  For more about obesity prevention, increasing access to physical activity, or what other communities are doing to encourage wellness, visit the Partnership for a Fit Kentucky’s blog http://www.fitky.org/category/blog/.

Tuesday, June 28, 2016

KentuckyOne under state investigation for critical staff cuts

U of L Hospital   (Photo from WDRB-TV)
The state is investigating whether patient care is unsafe at University of Louisville Hospital because of staff cuts, particularly in nursing, made by KentuckyOne Health.

The Courier-Journal reported June 9 that Dr. J. David Richardson, a prominent surgeon and current president of the American College of Surgeons, said cuts in nursing and other staff had caused a “major patient safety issue” and were “destroying the hospital.”

Richardson said in an email to university officials that Intensive Care Unit patients often cannot be moved to a more appropriate setting because there are “no available beds,” even though there are dozens of empty beds around “but they are simply not staffed,” The C-J's Andrew Wolfson reported. Richardson also said the hospital is poorly staffed at night, requiring patients to be held in the emergency room until 9 or 10 the next morning, when more nurses are available.

Beth Fisher, a spokeswoman for the Cabinet for Health and Family Services, confirmed Friday that its Office of Inspector General has an open investigation of the hospital. The office investigates hospitals in the state for the Centers for Medicare and Medicaid Services, which can terminate a hospital’s federal reimbursements in case of serious offenses.

KentuckyOne spokesman David McArthur said the company is awaiting the inspector general's report and has already assembled a group that will "evaluate and address any specific points and recommendations as soon as they are received," Wolfson reports. McArthur said the company is committed to quality and safety and has been investing “significant resources to continually improve key areas of hospital performance.” He also noted that staff reductions occurred more than two years ago.

Nevertheless, other physicians and hospital officials have confirmed Richardson’s assertions, including Dr. Susan Galandiuk, who told Wolfson that layoffs and cuts have forced the hospital to hire temporary “traveling nurses” unfamiliar with procedures.

“You are in the operating room with nurses who have no idea what equipment you are using or what they are supposed to be doing,” said Galandiuk, a colorectal surgeon who is editor-in-chief of a leading scientific journal in that specialty. “It is sad to see the deterioration.”

McArthur insisted that traveling nurses are trained on equipment and procedures unique to U of L Hospital.

The investigation is the latest problem for the hospital and KentuckyOne Health, whose parent company, Catholic Health Initiatives, lost $125.9 million in the last quarter of 2015 and has run up $9 billion in debt.

The Joint Commission, which accredits U.S. hospitals, found 31 deficient areas at U of L Hospital in January. They include problems with infection prevention and transfusion errors, as well as in broader categories. The hospital was accredited, but with the requirement of a follow-up survey. McArthur told Wolfson that none of the problems were considered serious and all have been addressed and corrected.

The hospital received a “D” grade in April from the Leapfrog Group, an independent organization founded by employers and medical experts. Two of KentuckyOne’s other hospitals in Louisville – Jewish and Sts. Mary & Elizabeth Hospital – got the same marks. The organization, which assigns letter grades to more than 2,500 U.S. hospitals based on medical errors, accidents, injuries and infections, says selecting the right hospital can reduce a patient’s risk of avoidable death by 50 percent.

KentuckyOne partnered with the University of Louisville in 2012. Former Gov. Steve Beshear blocked a full merger partly because of concerns about applying the Roman Catholic Church's Ethical and Religious Directives for Catholic Health Services at a public hospital, Maria Castellucci reported in Modern Healthcare.

Madisonville program aims to develop home-grown doctors

Photo from overseastraineddoctors.com
Rural areas are too often underserved by the medical community, but a Madisonville program targeting high-school seniors as prospective health-care providers is helping change that.

There are many programs in rural areas for students in the medical field, but most require students to relocate for six weeks during the summer to an urban area with a medical school, Jenny Smith reported in the Madisonville Messenger.

Baptist Health
's High School Rural Scholars Program reverses that requirement by allowing students entering their senior year of high school to gain experience in the medical field without leaving their home county.

HSRS students divide time between shadowing medical professionals and preparing for college entrance exams. They have access to a virtual classroom with college professors available via the internet to improve their knowledge base, as well as test-taking skills. It is held during the same time as the Governor's Scholars Program, targeting the "second tier" of students most likely to benefit from the virtual classroom.

Baptist Health's Trover Campus in Madisonville serves as the central support site for the program, program officials said in a release. Students from Hopkins County and its adjacent counties are considered for the program. The students work 30 hours each week and receive a small stipend for participating in the three-week program.

To date, 226 students have participated in the program; 75 percent of former HSRS participants are enrolled in or have have completed a health career training program, HSRS officials say. Dr. Jonathan Moore is an HSRS alumnus who is currently finishing his residency in Madisonville.

"My time with the High School Rural Scholars showed me the value of a physician to their community," Moore said in the Messenger. "It inspired me to become a physician so that I could improve the lives of others."

The Trover Campus was established in 1998 as a branch of the University of Louisville School of Medicine. The HSRS program was founded two years later. Campus Associate Dean Dr. Bill Crump told Smith that he shares the same vision for rural health as did Dr. Lowman Trover, who founded Trover Clinic, now Baptist Health Madisonville, in 1953.

"When I moved here 18 years ago, it was because I saw the potential to realize Dr. Trover's dream of 'growing our own doctors,'" Crump said, "but as we began, we just weren't being successful in getting students from the small towns in our area admitted into medical school. We knew we had to begin early to raise their expectations and sharpen their academic skills.

"When I had the initial idea for this program, we had well-meaning adults tell us high school seniors just aren't mature enough to benefit from such a program," he continued. "Our students have proven the concept valid, and I've been fortunate to see many of them develop into remarkable health care professionals."

The University of Kentucky partners with Morehead State University and several hospitals and clinics for a similar initiative, the Rural Physician Leadership Program. Much like HSRS, the UK program also strives to provide rural areas with qualified doctors.