Sunday, September 15, 2019

Adult obesity in Ky. reaches all-time high of 36.6%, fifth in U.S.; doctor says insurance needs to start covering obesity prevention

By Melissa Patrick
Kentucky Health News

Kentucky adults just keep getting larger, reaching an all-time high for the number of obese adults in the state, ranking it fifth in the nation.

"As a society, as a whole, we're not quite convinced yet what a major problem this is," said Dr. Barbara Fleming-Phillips, an internist who helps run the weight management clinic at UK Healthcare's Barnstable Brown Diabetes Center.

Kentucky's adult obesity rate in 2018 was 36.6 percent, according to an annual report by Trust for America's Health and the Robert Wood Johnson Foundation. That's an increase of 6.7% , and 2.3 percentage points, from last year's rate of 34.3%, eighth highest in the nation.

The report says Mississippi and West Virginia have the highest rates of adult obesity, at 39.5%, and Colorado the lowest at 23%.

That said, all the state rates could actually be higher, says the report, since their numbers are based on the Behavioral Risk Factor Surveillance System, a continuous national poll; people self-report, and tend to over-report their height and under-report their weight. Obesity is calculated through body mass index, essentially a ratio of height to weight.

Supporting that theory, the national adult obesity rate is 39.6%, which comes from actual body measurements from the National Health and Nutrition Examination Survey.

The report for Kentucky shows that 68.5% adults in the state are either obese or overweight.

"Clearly things are going in the wrong direction in Kentucky just as they are in the rest of the country," said Fleming-Phillips. "And it's really a systemic, overall-society problem; it's not just a matter of counseling individual people on weight loss, which we do with my job, but it's a matter of looking at the entire system."

Strategies to combat obesity

Fleming-Phillips said it will take a "multi-pronged approach" to tackle excessive weight in Kentucky and the nation. She said that from her clinical experience, the most important contributor to weight loss is the diet, but added that exercise is definitely a component.

Nutritional education is needed in childhood, but adults also need nutrition education that teaches them to choose "real foods" over convenient, processed foods, Fleming-Phillips said.

As for exercise, she said because we are such a sedentary society with sedentary jobs, exercise must become a habit early on in a person's life; otherwise they will have to decide it is important.

Kentuckians don't exercise much. The report says Kentucky ranks No. 1 in the share of adults who say they are physically inactive: 32.3%.

The state also recognizes the need to focus its obesity efforts on children. That's because a child who is overweight when they start kindergarten is three times as likely to become obese by middle school compared to their peers, Christina Dettman, spokeswoman for the Cabinet for Health and Family Services, said in an e-mail.

For example, she said the State Physical Activity and Nutrition Program works to increase breastfeeding in birthing facilities, since studies show children who have been breast-fed are less likely to be obese. The program also works to implement healthy-food guidelines in work and community settings; to integrate nutrition and physical-activity standards into early-care and education systems; and to improve sidewalks, paths and bicycle routes throughout the state.

Dettman added that Kentucky has received a federal grant that can be used for evidence-based strategies at the local level to improve nutrition and physical activity. It will be allocated to 11 community health departments in Eastern and Western Kentucky. They include health departments in the Purchase District, Pennyrile District, Kentucky River District, the Cumberland Valley District, and Muhlenberg, Todd, Calloway, Christian, Pike, Floyd and Whitley counties. According to the Centers for Disease Control and Prevention, the grant is for $856,326.

The report notes that obesity levels are closely tied to social and economic conditions, finding that those with lower incomes are at higher risk of being obese as are people of color.

The obesity rate for blacks in Kentucky is 39.3%; for Latinos it is 30.9%; for whites it is 35.2%. About the same number of men and women are obese.

Baby boomers have the highest obesity rate at 43.8%, followed by those between the ages of 25 and 44 at 40%, seniors at 30.8% and those between 18 and 24 at 18.5%.

The report includes 31 recommendations for policy actions that are largely designed to improve access to nutritious foods, provide safe places for physical activity and to minimize the harmful marketing and advertising tactics that currently exist.

A few examples of its recommendations include the expansion of the Special Supplemental Nutrition Program for Women, Infants and Children to age 6 for children and for two years after birth for mothers, fully funding the WIC Breastfeeding Peer Counseling Program and taxing sugary drinks.

The push to expand WIC services is supported by an obesity decline seen in 31 states among 2- to 4- year-olds enrolled in the program between 2010 and 2014. Kentucky, with a decline of 18.2% to 13.3% respectively, was one of those states.

That said, Kentucky's older children haven't fared so well, with those between the ages of 10 and 17 having the third highest obesity rate in the nation, at 19.3%. And just like the state's adults, obesity rates among Kentucky's high school students continues to creep up and at 20.2% this group also ranks third in the nation for this measure.
Charts from report show figures from earlier years about childhood obesity in Kentucky, by age group
The latest Kentucky Health Issues Poll that asked about childhood obesity found that 56% of Kentucky adults saw childhood obesity as a serious problem for the state; another 35% said it was a problem, but not serious; and 6% saw it as no problem at all.

Obesity treatment and insurance

The American Medical Association recognized obesity as a disease in 2013, with hopes that the designation would change the way the medical community treats obesity, including how insurance companies would pay for the treatment.

But that has not happened, Fleming-Phillips said. Dedication to nutritional education and obesity prevention is still not a priority "anywhere in the medical system," she said.

"It's kind of baffling that obesity has been declared a disease -- and obviously there is a giant problem with obesity -- but insurance companies are not paying for obesity education and prevention or even treatment of the disease, medical treatment of the disease of obesity," she said.

The report also addresses coverage for obesity prevention, saying that while the law requires most insurance plans to cover preventive services, "there is great variability of actual implementation or uptake of these recommendations across insurers."

Chart from report shows the diabetes rate in Kentucky is up.
Being overweight or obese greatly increases the risk of developing other chronic diseases, like type 2 diabetes, high blood pressure, heart disease, stroke, and many types of cancer -- all conditions that plague Kentucky. Obesity is estimated to increase national healthcare spending by $149 billion annually, says the release.

About 14% of Kentucky's adults reported having diabetes, ranking the state seventh highest for this measure, and 39% of them reported having high blood pressure,which put the state at No. 5, the same rank it has for adult obesity.

Saturday, September 14, 2019

State investigating 3, probably 5, cases of e-cigarette lung illness

The state Cabinet for Health and Family Services is investigating three cases, and two probable cases, of a lung illness linked to electronic cigarettes "that has rapidly spread across the country, killing six," Bailey Loosemore reports for the Louisville Courier Journal.

Products at Derb E Cigs (Courier Journal photo by Bailey Loosemore)
Cabinet spokeswoman Christina Dettman "said she could not say where the local cases were reported or provide additional information about who got sick," Loosemore reports.

At least 380 confirmed and probable cases of the illness have been reported in 36 states. The Centers for Disease Control and Prevention has not determined its cause but says "most patients have reported a history of using e-cigarette products containing THC," tetrahydrocannabinol, the psychoactive ingredient in marijuana.

"Local health advocates, however, say e-cigarettes still contain nicotine and other toxins that can be harmful to health, and a ban could prevent young users from developing future issues," Loosemore notes. On the other hand, a leading dealer of e-cigs in Louisville, Troy LeBlanc of Derb E Cigs, told the CJ they shouldn't be blamed because "It's all street-level drugs that are causing the illnesses."

LeBlanc told Loosemore that the Trump administration's announcement that it would ban all flavorings in e-cigs except tobacco would "create the largest black market the country's ever seen since Prohibition." She writes, "LeBlanc said the removal could also end up encouraging vaping users to purchase more black-market oils or to return to smoking traditional cigarettes that are proven to be harmful to health."

Reported $12 billion settlement by Purdue Pharma prompts Bevin to try to associate Beshear with state's much smaller settlement

Republican Gov. Matt Bevin spoke to Democratic Attorney General Andy Beshear, as Democratic Secretary of State Alison Grimes seemed to react, before Bevin addressed the state legislature. (Photo by Michael Reaves, Cincinnati Enquirer)
Reports that Oxycontin maker Purdue Pharma will pay $12 billion to settle many other states' claims of damages from the opioid epidemic has brought fresh attention to Kentucky's settlement for 2 percent of that amount in 2015.

The $24 million deal was struck by Democrat Jack Conway, then the state's attorney general, who had just lost the November 2015 governor's election to Republican Matt Bevin. (The suit had been filed in 2007 by Democrat Greg Stumbo, who said it could result in a settlement of $1 billion.)

Meanwhile, Democrat Andy Beshear had been elected attorney general, and after taking office in January 2016 he approved a retroactive $4 million contract for work on the case by a Louisville firm that later made Conway a partner.

While he was a candidate, Beshear was at partner at another law firm, which represented Purdue Pharma in the case. He has said he had no direct involvement in it, but now he is running for governor against Bevin, who went after him in an official statement issued by his office Sept. 11, soon after reports of the possible $12 billion settlement.

"It’s a tragic day for the thousands of Kentucky families who have suffered heart-wrenching pain from the scourge of the opioid epidemic," Bevin said. "I am deeply troubled that Kentucky is forced to stand helplessly by, as more than 20 states and nearly 2,300 local governments across the country receive a historic settlement."

Bevin alleged that Conway and Beshear's law firm "struck a corrupt deal, ensuring that Purdue would be let off the hook by paying only $24 million to Kentucky, even though our state was one of the first and hardest hit by opioids." Noting the retroactive contract, he said, "This crooked deal is one of the biggest frauds ever committed on Kentuckians."

Beshear campaign spokesman Sam Newton replied, "Andy Beshear has been the most aggressive attorney general in the country when it comes to taking on the big drug companies that poisoned our communities and killed our neighbors." He added that it was "shameful" for Bevin to use his office to make "a patently false political smear about something that happened before Andy ever took office."

As attorney general, Beshear has filed nine lawsuits against drug companies for their roles in the epidemic. "Beshear famously walked out of a committee hearing in October 2017 after being grilled by legislators about whether he had anything to do with the $24 million settlement, Phillip Bailey writes for the Louisville Courier Journal.

Earlier that year, Beshear told reporters, "I wasn't a named counsel on that, and I don't recall doing any work on it. I was there a long time; I don't want to suggest that no one asked me a question about what General Conway was like or not like, but I was not an active participant in that case."

Bailey notes, "Kentucky's rate of opioid-involved deaths was 27.9 per 100,000 people, which was almost twice the national average, according to the National Institute of Drug Abuse."

Friday, September 13, 2019

Legislator questions state loan of $50 million to U of L for Jewish Hospital, notes at-risk rural hospitals don't get similar support

U of L Health CEO Tom Miller spoke
at the meeting. (Photo by Melissa Patrick )
By Melissa Patrick
Kentucky Health News

Kentucky lawmakers asked a University of Louisville official why the state should loan U of L $50 million to help it buy financially distressed Jewish Hospital, suggesting the state was picking "winners and losers" since many rural hospitals are in the red and the state isn't helping them out.

At the Sept. 9 Medicaid Oversight and Advisory Committee meeting, Sen. Stephen Meredith, R-Leitchfield, the co-chair, called the state loan "precedent setting." Meredith said he appreciated the desire to maintain the safety-net hospital, but some rural hospitals are experiencing similar plights.

He pointed to Pineville Community Healthcare in Bell County, which recently sold in a bankruptcy auction.

"Are we picking winners and losers when we participate in these kind of efforts?" he asked. "I guess very simply: Why should we spend $50 million for Jewish, but we're not going to do anything for Pineville Community?"

Meredith (WKYT-TV image)
Meredith might have picked any one of several Kentucky rural hospitals as an example.

A report by Navigant Consulting in February found that 16 of Kentucky's rural hospitals, one-fourth of the total, are at high risk of closing unless their financial situations improve. The hospitals are not listed by name. And since 2009, Kentucky has had five rural hospitals close, according to The Cecil G. Sheps Center for Health Services Research at the University of North Carolina.

U of L Health CEO Tom Miller said he couldn't speak to issues related to Pineville hospital, but said U of L wouldn't have moved forward without a partnership with the state and two foundations.

"We believed at the time and we still believe today that there is no one who can take care of these patients" if Jewish closes, he said, stressing that it is not just a Louisville hospital, but a regional facility. He said a third of its in-patient visits are from outside Jefferson County and over 40 percent of its physician visits are by patients from other counties. It also has Jewish Hospital Shelbyville.

Miller said Jewish sees 35,000 emergency patients a year and has between 200 and 250 in-patients a day, and if its heart-transplant program closed, heart patients, many of them very poor, would have to travel either to Lexington, Indianapolis or Nashville for a transplant.

Last month, U of L announced it would buy Jewish and its associated facilities, collectively known as KentuckyOne Health, with help from the state and two foundations. The state's committed portion is $50 million, through a first-of-its-kind loan from the Kentucky Economic Development Finance Authority. The loan must still be approved by the legislature.

Senate Minority Leader Morgan McGarvey, D-Louisville, voiced concerns that the loan far exceeds the existing KEDFA loan limit of $500,000 and doesn't meet the usual requirement to create jobs.

"This loan obliterates every single criteria of being a KEDFA loan," McGarvey said. "What happens if that's challenged and you all are not actually allowed to get the money from KEDFA?"

Miller said U of L is scheduled to close on the deal Nov. 1, even if the state doesn't furnish the $50 million loan. However, he said without the funding it would have to shift resources and cut back on capital improvements at Jewish.

After the meeting, Miller told reporters U of L will have to spend about $40 million a year to maintain the hospital, Morgan Watkins reports for the Louisville Courier Journal.

McGarvey referred to a secretly recorded transcript from a private meeting between Miller and KentuckyOne Health physicians. Chris Otts reported for WDRB that Miller told the doctors that U of L Health could "be successful" with the takeover even without the $50 million loan from the state.

The meeting included a discussion about a plan to expand U of L Hospital. "How are we supposed to think that this isn't just a way of financing a new expansion of U of L Hospital down the road, and you're going to close down Jewish Hospital and sell off the assets?" asked McGarvey.

Miller said the transcript was from an unreliable source. He said there was a discussion about a separate plan to expand the university medical center with the physicians at Jewish "if we didn't go forward with KentuckyOne and those plans have been put on hold."

Meredith cut off McGarvey's pointed questioning, but said the topic would be discussed again. "We've got some serious issues and reservations about this," he said. The leaders of the Republican majorities in the House and Senate have voiced support for the loan, favored by Gov. Matt Bevin.

Most diagnosed with ovarian cancer die of it, but a special type of screening, free at six sites in Kentucky, can reverse the odds

State legislators joined University of Kentucky officials to promote ovarian cancer screening. (UK photo)
Ovarian cancer is deadly sneaky. When detected early, it is often curable, but most women who have it don't have any symptoms until it has progressed to an advanced stage, when survival is unlikely. Screening and early detection are critical to saving lives.

As part of National Ovarian Cancer Awareness Month, UK HealthCare is celebrating its Markey Cancer Center's Ovarian Cancer Screening Program, which screens women free of charge at six locations: Lexington, Elizabethtown, Somerset, Prestonsburg, Maysville and Paducah.

For 50 years, ovarian cancer has caused more deaths than any other cancer of the female reproductive system, and is fifth in cancer deaths among women.

The American Cancer Society estimates that in 2019, about 23,000 women will get a new diagnosis of ovarian cancer and about 14,000 of them will die from it. In Kentucky, the ACS estimates about 280 women will be newly diagnosed with ovarian cancer this year and 190 will die from it. Thus, the predicted national death rate is 61 percent, the Kentucky rate 68 percent, probably because Kentucky women don't get screened as much.

Dr. John R. van Nagell Jr., a gynecologic oncologist at the cancer center, said the five-year survival rate of women whose cancer was detected by screening is 86 percent, twice as high as the rate among those who don't get screened.

“While regular pelvic examinations are important and can detect many other abnormalities, including cervical cancer, they are not effective in detecting ovarian cancer in its earliest and most treatable stages,” he said in a release.

Van Nagell and his colleagues started the screening program in 1987 to see if the use of transvaginal sonography, a form of ultrasound, could detect ovarian cancer early. The painless, radiation-free procedure is able to detect tumors that are too small to be diagnosed during a gynecological exam.

Research from the screening program, published in the medical journal Obstetrics and Gynecology last year, found that annual ultrasound screening of women who are at risk of ovarian cancer and have no symptoms can save the lives of those who unknowingly have early-stage ovarian cancer. graphic
Over the program's 32 years, nearly 350,000 free screening examinations have been provided to more than 48,000 Kentucky women; 607 ovarian tumors, more than 100 of them malignant, have been detected.

Women from every county in the state have participated in the program, according to the release.

The Kentucky Extension Homemakers Association and the Telford Foundation provided the initial funding for the program.

“We are extremely proud of the Kentucky Extension Homemakers Association’s dedication to this life saving program,” Nancy Cox, dean of the UK College of Agriculture, Food and Nutrition, said in the release. “Their fundraising efforts have raised nearly $1.5 million but their work really goes beyond fundraising. They routinely participate in the screening program, organize trips to screening sites from around the state, promote ovarian cancer awareness, and host educational events regarding ovarian cancer. This program positively impacts Kentucky women and represents the kind of research that should be conducted by a state's land-grant university.”

The UK screening program is free and open to women age 50 or older, or women over 25 who have a family history of ovarian cancer. For more information, call 859-323-4687 or 800-766-8279.

Thursday, September 12, 2019

More than 100 people gather in Owensboro to talk about meth; police officer says they're losing battle with highly addictive drug

Crystal methamphetamine (Drug Enforcement Administration)
The methamphetamine problem is so bad in Owensboro that the city commissioner hosted a community forum to discuss it, Katie Pickens reports for the Owensboro Times.

“This issue affects almost everyone in this community,” Commissioner Larry Conder told a crowd of more than 100 at the Sept. 10 forum.

Methamphetamine is also called meth, crystal, chalk and ice, among other things. It is an extremely addictive stimulant.

The forum included a panel offering perspectives from local law enforcement, a district judge and the director of a local group fighting substance abuse, all of whom said the issue with meth in Owensboro and Daviess County is worse than it's ever been, Pickens reports.

“We’re seeing a shift from smokers” to those who inject the drug, said RonSonlyn Clark, senior director of substance-abuse services at RiverValley Behavioral Health. “Just ask those who work at the needle exchange clinic. We’re seeing an increase in crisis services from meth-induced psychosis, and we’re seeing an increase in dangers to law enforcement.”

Owensboro Police Department Street Crimes Unit Supervisor Sgt. Michael Nichols said police are losing the fight against meth, Pickens reports.

“There’s not a section of Owensboro devoid of this problem,” Nichols said. “Meth is the one demon that shows no mercy — it doesn’t care what [your race or nationality is]. Once it gets its claws into you, it’s a wrap. It truly is the devil, in my opinion.”

Nichols said that in 2016, the department found 3.8 pounds of meth. In 2017, the number was 8.9 pounds and in 2018 it was 14.1 pounds. Already this year, he said, 18.38 pounds have been logged into evidence, but most of the meth is never uncovered by law enforcement, Pickens reports.

Clark told the crowd that meth takes a financial toll on a community, saying that every dollar spent on meth equals $7.46 taken from the community, Pickens reports.

Mental Health Court Judge Lisa Jones said that while the problem was worse in that area than other parts of the state, all of Kentucky is struggling with the problem, which doesn't get enough attention because of the epidemic of heroin and other opioids, Pickens reports.

"In Kentucky last year, there were 8,000 heroin arrests,” Jones said. “There were 35,000 meth arrests."

Panelists said meth takes an average of four to seven attempts to quit, taking an average of 20 years off a user's life; contributes greatly to abusive relationships and neglectful households and, as estimated by Nichols, contributes to 75 to 80 percent of violent incidents.

Anyone seeking treatment for a substance use disorder, including a meth addiction, can find help on the state's treatment locator or on the treatment hotline 1-833-8KY-HELP.

Student-driven project at Hazard High that advocated for tobacco-free policies is named a Healthy Kentucky Policy Champion

Several HHS TAP members advocated for the tobacco-free
schools bill, which passed, at the state Capitol this spring.
The Foundation for a Healthy Kentucky has awarded a student-driven project to educate youth and community members about the dangers of tobacco use as the latest recipient of a Healthy Kentucky Policy Champion Award.

The project was part of the Hazard High School Tobacco-free Ambassador Partnership (HHS TAP) program, which is a partnership between the school and the University of Kentucky. It is supported by the CVS Health Foundation.

"The award recognizes the students' progress in advocating for smoke-free and tobacco-free policies and talking with peers about reducing their tobacco use," a news release form the foundation said.

"My involvement with TAP has made me realize that the only thing you need to do to make a difference is have courage. I'm so thankful for the message TAP shares -- that students have a voice, and we need to share the dangers of the addiction that takes so many youths each year," said senior Zoe Pennington, one of 24 students participating in the program.

The others are Brittany Vires, Makenzie Baker, Cage Watts, Simone Beverly, Trajon Campbell, Catherine Cornwell, Kyleah Maggard, Shelbi Ritchie, Madison Eddington, Bella Dawhare, Jared Hoskins, Dakota Sharpey, Andrew Nyguen, Kennedi Artrip, Ava Dixon, Laura Hanna, Abby Stoffel, Ben Handshoe, Jarrett Napier, Sarah Jo Campbell, Kendra Miller, Alexa Muha, and Katie Braman.

During the 2018-19 school year, the students conducted surveys, participated in policy advocacy training and organized and hosted a variety of activities and events to raise awareness of what can be done to decrease tobacco use in their community. In addition, they wrote letters to the legislature and visited Frankfort to support the tobacco-free schools bill that passed in 2019.

One of their projects included a video of the school's retired band director, an iconic figure and  former smoker, about her success in kicking a 30-year smoking habit. The students also identified opportunities to strengthen existing smoke-free and tobacco-free policies in their community.

Melinda Ickes, an associate professor in the UK College of Education, said many of the students were initially uncomfortable talking about tobacco-related issues in their community, "given the negative response typically elicited," but have since "built a foundation to continue work in this area" and are now "eager to talk about tobacco and the benefits of evidence-based tobacco policies."

"This group of students is having an impact on youth and adults in their community," said foundation Community Advisory Council members Fran Feltner and Melissa Slone.

The HHS TAP program and other winners are now eligible for the Healthy Kentucky Policy Champion of the Year award, which comes with a $5,000 grant from the foundation to a Kentucky-based nonprofit of the winner's choice. The winner will be announced at the foundation's annual health policy forum Sept. 23 in Lexington.

Wednesday, September 11, 2019

Trump moves to ban most flavored electronic cigarettes; pro-health groups in Kentucky cheer, urge quick action

A young person uses an electronic cigarette. (Getty Images)
Citing his 13-year-old son as an example, President Trump signaled Wednesday that his administration would ban most flavored electronic cigarettes, which have caused an epidemic of e-cig use among teenagers across the country, including Kentucky.

“We can’t allow people to get sick. And we can’t have our youth be so affected,” Trump said during an Oval Office meeting with Health and Human Services Secretary Alex Azar, acting Food and Drug Administration commissioner Norman E. “Ned” Sharpless and first lady Melania Trump, who the president said feels “very, very strongly” about the issue because of their son, Barron.

"Azar said Wednesday the administration intends to 'clear the market' of flavored e-cigarettes," reports Laurie McGinley of The Washington Post. "Azar said the FDA is finalizing a plan on flavored e-cigarettes in the next several weeks that probably would go into effect a month later. The policy, he said, would require most flavored e-cigarettes, including mint and menthol, to be removed from the market. The flavored products would not be allowed back on the market until — and if — they receive specific approval from the FDA," which would require them to show a health benefit.

Azar said, "No child should ever use a vaping or e-cigarette product." Despite the industry's terminology, e-cigs do not produce a vapor, but an aerosol, with a wide range of particulates.

Administration officials said tobacco-flavored e-cigs would not be banned, to give smokers an alternative to regular cigarettes. "Azar warned, however, that should it become clear that kids are also becoming attracted to the tobacco-flavored e-cigarettes, the administration will take action against those products as well," Beth Wang reports for Inside Health Policy.

"Those products tend to be less appealing to young people, McGinley notes. "The administration’s move comes as health officials across the country investigate more than 450 cases, including six deaths, of lung disease linked to vaping. Many patients have reported using cannabis-related products, but authorities have not ruled out any specific type of vaping."

UPDATE, Sept. 12: The Foundation for a Healthy Kentucky and several other groups announced their support for the plan, saying, "We support a ban on non-tobacco flavored electronic cigarette products, including fruit, candy, mint and menthol flavored products - nationwide, and urge the Food and Drug Administration to act as quickly as possible to implement the ban."

The statement went on, "Flavored tobacco products are an unfettered pipeline for turning youth experimenters into adult nicotine addicts. The appeal of flavored tobacco to adolescents and teens is a key reason the FDA banned flavored cigarettes in 2009. Sadly, the latest data showing yet another spike in youth e-cigarette use from one in five to more than one in four teens was entirely predictable given the thousands of flavored e-cigarette products on the market. Four out of five 12- to 17-year-olds who have used tobacco started with a flavored product, and four out of five current youth tobacco users have used a flavored tobacco product in the past month. Flavors are among the most common reasons for youth and young adults say they use e-cigarettes."

Joining the foundation in the statement were the Kentucky School Boards Association, the Kentucky Chamber of Commerce, hospital group Baptist Health, insurance company Humana, the American Heart Association, the Kentucky Medical Association, the Kentucky Health Collaborative, the Kentucky Equal Justice Center, Kentucky Youth Advocates, the Kentucky Hospital Association and the Kentucky Cancer Foundation.

Sheila Schuster, a longtime and leading advocate for mental health, is named the latest Healthy Kentucky Policy Champion

Sheila A. Schuster
The Foundation for a Healthy Kentucky has named psychologist and mental health advocate Sheila A. Schuster of Louisville as the latest Healthy Kentucky Policy Champion for her more than four decades of leadership in advocating for those with mental illness and other disabilities, and for her efforts to increase access to health care across Kentucky.

"Her vast network of connections in the health care sector, as well as in the health policy arena, make her insights invaluable to professional and advocacy organizations," said Kathryn Mershon, who nominated Schuster for the award.

One of Schuster's most recent successes was "Tim's Law," which allows Kentucky judges to order outpatient treatment for persons with several mental illness. The law, passed in 2017, is intended to help break the cycles of homelessness, incarceration and involuntary hospitalization.

Other successes include leading policy efforts that provide insurance parity for mental illness and addiction, treatment for autism, increases in mental health professionals in schools, and elimination of barriers to health care access, particularly for persons with disabilities or those living on very low incomes.

Schuster currently leads the Advocacy Action Network, an umbrella organization that includes groups addressing health care, mental health, social justice and disability issues. She also chairs Kentucky Voices for Health, a coalition to improve Kentucky's health, and leads the Kentucky Mental Health Coalition, which comprises more than 80 organizations. She chairs the Behavioral Health Technical Advisory Committee to Kentucky's Medicaid program.She has held numerous leadership positions, including president and executive director, with the Kentucky Psychological Association. She is also a former member of the health foundation's board of directors and is currently a member of its Community Advisory Council.

Ben Chandler, president and CEO of the foundation, added that when he was Kentucky's attorney general, Schuster was among a small group of individuals who worked on a lawsuit that ended in the settlement which, in turn, created the endowment that funds the foundation. "Sheila was absolutely integral to the creation of the foundation in the late 1990s," Chandler said in the release.

Mental Health America of Kentucky Executive Director Marcie Timmerman pointed to Schuster's leadership with the 874K Disability Coalition, which she said has resulted in the creation of the bipartisan Engage and Empower Caucus in the Kentucky House. "It is not an understatement to say Dr. Schuster has been involved in every piece of good mental-health legislation enacted in the past few decades," Timmerman said.

Schuster and other winners of the award are eligible for the Healthy Kentucky Policy Champion of the Year award, which comes with a $5,000 grant from the Foundation to a Kentucky-based nonprofit of the winner's choice. The winner will be announced at the foundation's annual health policy forum Sept. 23 in Lexington.

Bank buys bankrupt Pineville hospital, says it will probably lease it back to local group to keep it operating

Pineville Mayor Scott Madon and others celebrated the takeover
and renaming of the hospital during its bankruptcy proceedings.
(File photo by Ray Welch, Middlesboro Daily News)
A Tennessee-based bank has bought the 120-bed hospital in Pineville, and says it plans to lease it to a community group that has kept it afloat through bankruptcy.

"First State Bank of the Southeast, which operates branches across Kentucky and Tennessee, closed on its purchase of Pineville Community Healthcare in Bell County last week for $2.6 million, according to state bankruptcy court filings," Alex Acquisto reports for the Lexington Herald-Leader. "The regional bank was the second highest bidder in a sealed bid auction behind Louis Volpini, who bid $7 million on behalf of Cura Healthcare Inc. That group, though, lost its top ranking when it failed to make the required initial deposits, including a 20 percent cash deposit of $1.4 million." That allowed First State to buy the hospital for $2.8 million on Sept. 5.

The bank will not operate the hospital, and will probably lease it to "a non-profit group of local stakeholders who took over the hospital and changed its name" during the bankruptcy, Acquisto reports, citing John Sosbe of Georgetown, the bank's attorney in the matter. The hospital is a “major asset to the community and [First State Bank] wants to keep it as an asset to the community,” he said.

Read more here:

Sunday, September 8, 2019

Republican ad says Beshear has 'radical views on health care;' he calls it a smear and says Bevin wants to take away coverage

By Al Cross
Kentucky Health News

Health care has become a major issue in the Nov. 5 election for governor, with a Republican ad accusing Attorney General Andy Beshear of having "radical views on health care." The Democrat calls the ad a "smear" and says he is opposing moves by Republican Gov. Matt Bevin that Beshear says would take away many Kentuckians' health coverage.

The 30-second ad from the Republican Governors Association says, "Andy Beshear supported the government takeover of health care; now Beshear supports giving taxpayer-funded health benefits to people who CAN work but choose not to. We can't afford Andy Beshear's radical views on health care."

Beshear opposes Bevin's efforts to require work, volunteering, schooling or other "community engagement" of able-bodied, childless people who are covered by the 2014 expansion of Medicaid by Beshear's father, then-Gov. Steve Beshear (under the Patient Protection and Affordable Care Act, better known as Obamacare), to people with incomes up to 138 percent of the federal poverty level.

Bevin asserted in July that "hundreds of thousands of people" on Kentucky Medicaid "could be going to work, should be going to work, and choose not to go to work." A study by researchers working for his administration, but doing research on their own, estimated that about 48,000 people on Medicaid would not currently meet the community-engagement requirements; they estimated that the number is about 36 percent of those who would be subject to the requirements.

The requirements have been blocked twice by a federal judge in Washington, D.C. His latest decision, and a similar one against similar work requirements already implemented in Arkansas, have been appealed to the U.S. Court of Appeals for the District of Columbia. Three judges of the court will hear the cases Oct. 11 but they are not expected to rule before the election.

Bevin has predicted that the Supreme Court will ultimately decide the issue, and has issued an executive order that would abolish the Medicaid expansion six months after any final court decision against his work requirements.

In a press release issued in response to the spot, the Beshear campaign did not mention the work rules, but said the ad "tries to smear Andy Beshear’s strong record of fighting to lower the cost of health care for working families and protect coverage for Kentuckians with pre-existing conditions."

The release notes that Bevin is among officials who appealed a ruling blocking association health plans, which would make it easier for small employers to form insurance groups. The proposed rule for such plans says they can't deny coverage based on pre-existing conditions, but critics of the plan say they could simply refuse to cover certain conditions they don't want to cover.

The Beshear release also includes links to news stories about Bevin calling for the repeal of the Affordable Care Act and supporting a lawsuit that could lead to the 2010 law being struck down, without actually mentioning the law.

The Republican ad includes images of an angry Sen. Bernie Sanders, an anguished-looking Rep. Alexandria Oscasio-Cortez and a yelling Sen. Elizabeth Warren, saying "Washington liberals want to eliminate employer-provided health coverage, forcing everyone into a single, government-run plan. Every single person." That is not at issue in the election for governor. Both political parties often try to associate the other party's candidates with personalities or proposals that their public-opinion polls show are unpopular among voters in the election being contested.

Geriatric doctor offers tips for aging optimally; it's much-needed advice for Kentucky seniors, who rank 49th for seniors' health photo
As life expectancy for both men and women keeps rising, it's important to adopt a handful of healthy habits that include things like exercising and staying social to ensure that you "age optimally."

That was the main message of Dr. Christian Furman, a geriatric physician from Louisville, on an episode of "Kentucky Health" with Dr. Wayne Tuckson on Kentucky Educational Television, Patrick Reed reports for KET.

Furman is interim chief of internal medicine, palliative medicine and medical education at the University of Louisville. She is also medical director of U of L’s Institute for Sustainable Health and Optimal Aging.

She told Tuckson that while “geriatric” applies officially to those age 65 and older, the field of geriatrics provides much of its expertise around what she called the "older old," those over 80. She added that most people can stay with their primary-care physician until they are 75, but should consider switching over to a geriatric physician at that age.

As for tips on living a long life, Furman said her advice is to adhere to the habits that are responsible for good health in general. She also noted that those who follow a healthy lifestyle during their youth and middle age are more likely to have a high quality of life during their senior years.

Here are her tips for "optimal aging" as reported by Reed:
  • Exercise: She said, “You don’t have to do major exercise, just move," which she said could involve walking around the neighborhood.
  • Follow a well-balanced diet: This means eating a diet that is low in red meat, avoiding foods that are high in cholesterol, and eating more fruits and vegetables.
  • Eliminate tobacco use.
  • Adhere to only moderate alcohol intake.
  • Stay socially engaged: Furman says research shows that social isolation has negative health effects. “It’s like smoking 15 cigarettes a day, which is a lot of cigarettes,” she says.
  • Yearly physicals and preventive screenings: Furman encouraged seniors to keep up with their yearly doctor's visits and preventive screenings, such as mammograms and colonoscopies.
  • Regularly re-visit the need for each of your medications: “There is research that shows, the more medications you take, the more problems you will have,” she said. “About five or six is the tipping point. Once you get to six medicines, you will have more side effects and adverse drug reactions and problems.”
Overall, Furman encouraged older folks to continue doing everything that they have always done that brings them pleasure and fulfillment, if they are able to -- including sexual relations, Reed writes.

“You want people to be sexually active,” she said. “Sometimes sexual activity is different for different people, sometimes it’s cuddling, being intimate through skin contact. Sometimes the actual intercourse is hard for older people, but it doesn’t have to be.”

Furman said the goal is to keep older folks as functionally independent as they can for as long as they can, recognizing that they will not be able to function at the same pace or intensity as they did when they were younger, Reed reports.

“They should still do the things they love, but take a rest,” Furman said. “Sit, recuperate, and get up and do it again. They can still cook dinner, or decorate for the holidays. But for people who used to decorate three rooms, three Christmas trees – well, just do one room, and one Christmas tree. Everything in moderation. It’s really very individualized, but it’s totally not based on their age.”

All of this advice is especially important for Kentucky seniors, who are among some of the most unhealthy seniors in the nation. According to the most recent America's Health Rankings Report, Kentucky ranks 49th for senior's health and has been in the bottom 10 states for this measure since 2013, the first year AHR did the report.

By 2030, the U.S. Census Bureau projects that one in every five people in the United States will be 65 or older and by 2035 older people are projected to outnumber children for the first time in U.S. history.