Friday, December 30, 2011

Beshear says no to hospital merger

Gov. Steve Beshear has said no to the much-discussed merger between three major Kentucky health systems, which, because it required his blessing, puts an end to the proposal.

"After exhaustive discussions and research, I have determined that this proposed transaction is not in the best interest of the commonwealth and therefore should not move forward," he said. "In my opinion, the risks to the public outweigh the potential benefits."

The merger would have been between University of Louisville's University Hospital, Jewish Hospital & St. Mary's HealthCare and Saint Joseph Health System, owned by Catholic Health Initiatives. Because Saint Joseph would have had majority control in the deal, the other facilities would have had to adhere to Catholic health directives, which affect procedures such as elective abortions, sterilizations, artificial insemination and euthanasia. (C-J photo by John Rott)

"That raised concerns among many community members and leaders, who also worried about the possibility of more limitations in the future if Catholic directives change," reports Laura Ungar of The Courier-Journal.

Beshear said the merger would result in considerable legal and policy concerns. "However, most troubling to me is the loss of control of a public asset," he said. "University Hospital is a public asset with an important public mission, and if this merger were allowed to happen, U of L and the public would have only indirect and minority influence over the new statewide network's affairs and its use of state assets."

Attorney General Jack Conway applauded Beshear's call. "I believe he ultimately made the appropriate decision on behalf of the commonwealth's interests," he said.

Hospital officials expressed disappointment, saying the "greatest beneficiaries of the proposed merger" would have been the patients of the commonwealth.

Beshear acknowledged the changing face of health care landscape does present new problems, but added he is committed to helping University and Jewish Hospital & St. Mary's HealthCare reach "our shared goals of providing quality care, especially to our poorest and most vulnerable citizens, as well as finding ways to ensure both facilities remain on strong financial footing," he said. (Read more)

Thursday, December 29, 2011

Herald-Leader endorses Sen. Higdon's pill-mill legislation

A pre-filed bill that would require background checks for people planning to open pain clinics, prohibit convicted felons from running them, and require that a physician in such a clinic own part of it, is a step in the right direction in fighting against pill mills, the Lexington Herald-Leader says in an editorial.

The bill has been pre-filed by Sen. Jimmy Higdon, R-Lebanon, right. "There are things that can, and should be done legislatively in the short-term to make it harder for pill pushers to stay in business in Kentucky and, therefore, limit access to prescription pain pills for people who aren't in medical need of them," the editorial says, referring to a recent survey showing nearly a third of Kentucky adults know a friend or family member who have abused pain medicine. In Eastern Kentucky, 43.2 percent of respondents said "yes" when asked the question. in the Lexington area, it was 39.4 percent. Western Kentucky had the lowest number at 19.7 percent.

"Surprised? Perhaps not," the editorial reads. "Alarmed? Absolutely." (Read more)

Saturday, December 24, 2011

New Year's resolutions: How to stick to them, how to set up a game plan, and even a few you may want to consider making

Research-reporting service Newswise has compiled an extensive New Year's resolutions package, information particularly helpful to newsrooms in search of copy during the week between Christmas and New Year's. Use these items for tips and information that can encourage your readers to live healthier lives. (Illustration by Tara Kaprowy, Kentucky Health News)

Resolutions need a course of action

If you want to achieve your New Year's resolution goals, you need to be detailed about it, said Joshua Klapow, a clinical psychologist at University of Alabama at Birmingham.

If the goal is to lose weight, "You have to outline the days and times you will go to the gym, the menu adjustments you will make and who in your circle can help keep you accountable for these goals," Klapow says. He advises a "gut-check," asking yourself if you really want to commit to the resolution in the first place. "It's better to be honest than to fail.".

Other tips for success include:

• Be realistic about the goal; shoot for success instead of the stars
• Set short-term and long-term goals
• Be open to making adjustments to your resolutions.

Monitoring progress is also important. "Simply keeping a mental track will not cut it," Klapow said. "If you are dieting, write down the foods you eat. If you want to spend less, write down your expenses. This will give you a visual account of what is working and what is not."

An actual record will also establish the "three-day rule," which involves writing down the reasons you stopped if you've missed three days committing to your new habit or routine. It also involves picking a specific re-start date and putting the written record somewhere that can be seen.

It's also important to recognize limitations. "You have to arrange your life for success," Klapow said. "Buying junk food for your family while you are trying to diet is not going to help. If you want to save money, stop carrying credit cards. Control what you can control to make your goals more easily achievable." (Read more)

Use Monday to make resolutions stick

Almost 45 percent of Americans will make a New Year's resolution this year, but studies show many will fall off the wagon within the first week and almost half will break their resolutions within the year.

One trick to stay on track? "Make Monday the day to recommit to your resolution, evaluate progress and set your goals for the coming week," says research-reporting service Newswise.

"We think of Monday as the January of the week," said Sid Lerner, founder and chairman of The Monday Campaigns, a nonprofit initiative in association with Johns Hopkins, Columbia and Syracuse universities. "It's a call to action built into every calendar, giving you 52 chances for success." (Read more)

Secret to resolution success is to make attainable goals

"I think most people make resolutions that they don't achieve for many reasons, often because they seem so overwhelming," said William McCann, director of behavioral science education in Wake Forest Baptist's Medical Center. "So, from a psychological perspective, we should make resolutions that we are sure to be able to follow through on. While it seems counter intuitive, we should lower our expectations because we want to be able to say to ourselves by next Dec. 31st 'I did it.'"

McCann offers a sample list of resolutions:
• "I will eat a little less dried food this year."
• "I will drive a little more slowly this year."
• "I will help others a little more this year."
• "I will interfere in my children's lives a little less this year."
• "I will talk less and listen a little more."

"Doing a little bit is like a seed that might grow," McCann said. "Start little and see what happens in 2012." (Read more)

Resolution Solution: How to meet your goals

A recent study shows committing to a detailed plan to meet one's goal "not only makes it more likely to be done, but also gets it off your mind so you can think about other things." So says E.J. Masicampo, assistant professor at Wake Forest University. "The (plans) that work specify exactly what you are going to do, including when and where you are going to do it."

There are four elements to a good plan:
• It should specify what is the goal and in what situations it should be accomplished.
• The planner should know he or she is in control and the plan is not dependent on what someone else does.
• It should list specific opportunities to meet the goal.
• It should be a goal the planner is motivated to meet.

"You have to picture yourself carrying out your plan," Masicampo said. "That's where the power of the plans lie, in imagining yourself completing the tasks."

For people trying to lose weight, for example, Masicampo said people should make "if, then" plans. "An 'if, then' plan pre-decides how you will act in a given situation," he said. If a person goes to a restaurant, then they should plan to order a salad rather than cheeseburger. "Making a plan is like setting an alarm because you don't have to think about it under the alarm sounds and then you'll act." (Read more)

Ten resolutions to consider

The University of Buffalo offers its annual list of resolutions worth committing to, each of which is based on the research of its faculty:

1. Make returning war veterans feel at home.
2. Floss every day.
3. To lose weight, eat the same foods over and over. Repetition may discourage overeating.
4. Be a humble leader.
5. Talk to your child about bullying.
6. Combat loneliness by reading more fantasy novels.
7. Reflect on things that give life meaning.
8. Set up separate email accounts to avoid getting scammed.
9. Teach math to your toddler.
10. Be nice to nurses.
(Read more)

Thursday, December 22, 2011

Nursing homes want panel to review lawsuits against them

"A long-term care industry group wants a new law in Kentucky that would create medical review panels to evaluable potential lawsuits against nursing homes, personal care homes and some facilities for the intellectually and developmentally disabled," reports Valarie Honeycutt Spears of the Lexington Herald-Leader.

The panel would be made up of three physicians and chaired by an attorney who would not be allowed to vote. The panel's findings would be admissible in court. The panel would "help eliminate frivolous lawsuits against the long-term care industry," said Ruby Jo Cummins Lubarsky, president of the Kentucky Association of Health Care Facilities. "Kentucky's long-term care profession has seen a drastic increase in litigation from lawyers whose sole practice has been limited to targeting our nursing facilities. Their primary tactic is to exploit the integrity of our survey process with misleading advertisements designed to alarm the public about a supposed failure to provide quality care in our facilities."

The Kentucky Justice Association, formerly the Kentucky Academy of Trial Attorneys, is against the proposal because it "makes nursing home corporations less accountable for the neglect and abuse of Kentucky's elderly citizens," said Maresa Fawns, the association's executive director. Bernie Vonderheide, founder of Kentuckians for Nursing Home Reform, is also opposed, saying the formation of medical review panels is "blatantly unfair to residents of nursing homes."

The proposal has not yet been filed for the 2012 General Assembly. House Speaker Greg Stumbo, a lawyer, has said he "would never support any measure that would deny a person his or her day in court if injured," but added he understands "that small, rural nursing homes are in extreme jeopardy because of out-of-state predatory law firms. Given that, the only responsible thing is to gather information on the issue and keep an open mind." (Read more)

Child abuse reviews show failed communication in agency

A picture of failed communication is developing as reporters sift through 86 internal reviews of incidents of child abuse, says an editorial in today's Lexington Herald-Leader. The Cabinet for Health and Family Services released the reviews last week under court order.

"This pattern of failed communication only came to light because this newspaper and Louisville's Courier-Journal have aggressively pursued these records in court and Franklin Circuit Judge Phillip Shepherd has relentlessly pushed the cabinet to open the records," the editorial reads.

The piece highlights several instances where communication breakdown led to tragic events, beginning with the case of 9-year-old Amy Dye, right, in which a school nurse had written six reports about suspected abuse or injuries. The cabinet's file only contained three of them.

Madaline Grace Reynolds died when she didn't get the medicine she needed to treat her cystic fibrosis. The review found the child-protection worker did not look into whether or not her parents had filled her prescriptions.

"But the faulty communication doesn't stop there," the editorial reads, referring to Tuesday's hearing by the Interim Joint Health and Welfare Committee in which legislators came down hard on the cabinet for "failing to inform them about regulations that prevented it from investigating abuse by a sibling, such as in Amy Dye's case," the editorial reads.

"The cabinet, indeed the entire executive branch, has shown it won't fully address these issues without the hot, bright light of outside pressure," the editorial concludes. "The courts have acted responsibly and forcefully. Now, the legislature must take up the painstaking and painful job of examining the cabinet's work, finding the missed connections and fixing them." (Read more)

Substance abuse conference will be held at Lexington Marriott Jan. 18-19; attendance will be limited to the first 250 registrants

Seeking to build collaborations and partnerships to help deal with prescription drug abuse, a conference called "The Different Faces of Substance Abuse" will be held Jan. 18-19 at the Marriott Griffin Gate Resort in Lexington.

The featured speaker Jan. 19 will be Florida Attorney General Pam Bondi, who will lead a discussion about the fight against pill mills. Participants can also attend two of eight breakout sessions that day:
• Overcoming addiction and obstacles to treatment
• Take-back program
• Creating a local drug-free alliance
UK Cooperative Extension Service substance abuse prevention programs
• Creating a youth program
• The law-enforcement perspective
• A regional initiative aimed at reducing and preventing prescription drug abuse in youth
• Unique characteristics of prescription drug abuse and ways to target them

Registration starts at 10 a.m. Jan. 18. Presentations begin at noon. The first day's speakers include Demetria Antimisaris, assistant professor in the University of Louisville School of Medicine; Dave Hopkins, program manager for the Kentucky All Schedule Prescription Electronic Reporting (KASPER) in the Office of the Inspector General; Van Ingram, executive director for the Kentucky Office of Drug Control Policy, and Jared Combs, pharmacist clinical staff at UK HealthCare.

The conference is sponsored by the University of Kentucky's colleges of agriculture, social work and pharmacy; the Lexington Mayor's Alliance on Substance Abuse, the Fayette County Kentucky Agency for Substance Abuse Policy, the Kentucky Division of Behavioral Health and the Ohio County Assets for Youth.

Space is limited to the first 250 registrants. To register, click here. Cost is $100 plus hotel fees. For more information, click here.

Wednesday, December 21, 2011

Health insurance exchange benefits will be decided at the state level; Kentucky can now proceed to set up its exchange

For months, Kentucky officials have said the state cannot move forward with setting up a health-insurance exchange under the new federal health law because there weren't enough details about which benefits they had to offer. On Friday, the Obama administration answered that question when it "let states, rather than the federal government, define which medical benefits insurance companies will have to offer consumers starting in 2014," reports Noam L. Levey of the Los Angeles Times. "This is significantly more state-flexible and friendly than many would have expected," Alan Weil, head of the National Academy for State Health Policy, told Levey.

The law says that by 2014, each state must offer an insurance exchange, an online insurance marketplace in which people can choose from a variety of plans from companies like Anthem or Bluecross/Blueshield and then, for the most part, be given federal subsidies to help pay their premiums. About 30 million individuals and employees of small businesses are expected to use the exchanges. The plans in an exchange must cover a basic set of benefits, including hospitalizations, emergency care, newborn and maternity care and pediatric services, but until now the federal government could have decided how generous the benefits had to be.

"Under the guidance issued Friday, state leaders can define their own set of benefits by using an existing major health plan in their state as a benchmark," Levey reports. "That means that some states may require insurers to cover services such as chiropractic therapy and in vitro fertilization, while others may not."

It's this variability between states that worries some. "In passing a good deal of the decision-making to states, the administration has guaranteed that Americans will continue to face a patchwork of state regulations that make coverage uneven and inefficient," report Gardiner Harris, Reed Abelson and Robert Pear in a news analysis for The New York Times.

Some consumer advocates also worry the move will allow states to make benefits too meager. Timothy Jost, a law professor at Washington and Lee University, said the policies "could restrict, for example, the number of covered visits a pregnant woman could make to her obstetrician or which prescription drugs to pay for."

However, by passing the responsibility on to the states, "President Obama will most likely make his plan for health care reform more politically palatable," the Times reporters write. "States will be allowed to set benefits at levels similar to what they are now, making coverage not much more expensive than it is today."

While some Republican state officials were happy with the decision, saying it makes it easier for states to comply with the law, others opposed to the law were critical. "All they're trying to do is avoid making tough calls before the election," said Ed Haislmaier, a senior research fellow at the Heritage Foundation. (Read more)

State health department starts new ad campaign against secondhand smoke, including three 15-second TV commercials

The Kentucky Department for Public Health is launching a new campaign to educate Kentuckians about the dangers of secondhand tobacco smoke and its potential effect. The campaign is funded by $281,000 from the economic stimulus package of 2009 and about $90,000 from the federal Centers for Disease Control and Prevention. This week the department will start running television, billboard and radio advertisements to show the dangers of smoke that comes from the burning end of cigarette, cigar or pipe or the exhaled smoke from a smoker. The ads, which will run statewide, highlight the link between secondhand smoke and dangerous illnesses in both adults and children.

The ads, produced by Louisville-based Doe-Anderson, feature people being unwillingly exposed to secondhand smoke in places such as residences and cars. Each ad carries the tag line, “Secondhand smoke is 100 percent unsafe, 100 percent of the time.”

Kentucky’s smoking rate remains the second highest in the country, with 24.8 percent of the adult population identified as current smokers, and secondhand smoke exposure is equally high. The health department says 39.5 percent of Kentucky children live with someone who smokes – the highest percentage in the country. Secondhand smoke has become a major public health concern because it contains approximately 4,000 chemicals, many of which are known carcinogens, and is responsible for approximately 3,000 cases of lung cancer deaths among nonsmokers each year.

The campaign is another project of the Kentucky Tobacco Prevention and Cessation program. Community interventions for tobacco cessation are available through local health departments staffed with tobacco control specialists, and the program operates a toll-free telephone line, 1-800-QUIT NOW. It also provides technical assistance, with the Kentucky Center for Smoke Free Policy at the University of Kentucky, to assist communities in seeking smoke-free ordinances.

Tuesday, December 20, 2011

Nearly 1 in 3 Kentuckians say they know a friend or relative who has struggled with prescription-pill abuse, poll finds

Almost one in three Kentuckians say they have a friend or relative that has had problems stemming from prescription drug abuse, the Kentucky Health Issues Poll has found.

In Eastern Kentucky, 43.2 percent of respondents said "yes" when asked if a family member or friend had had problems because they had abused pain pills. In the Lexington area, it was 39.4 percent. Western Kentucky had the lowest number at 19.7 percent. Statewide, it was 31.9 percent.

"Although other studies have shown that Kentucky has among the highest levels of prescription-drug abuse in the nation, the latest survey helps illustrate how pervasive the issue has become in the state," reports Bill Estep of the Lexington Herald-Leader.

The survey, which polled 1,614 people, found that people ages 18 to 29 were more likely to have a friend or relative who had had a problem with pill abuse — 43.8 percent compared to 29.7 percent of people ages 46 to 64.

"Other findings include that 54.5 percent of those polled in Kentucky said they'd been prescribed a pain reliever such as OxyContin, Vicodin or Percocet in the past five years," Estep reports. "The rate in Appalachia was the lowest in the state, at 46.4 percent. That might reflect that there are fewer medical providers in that part of the state, and that fewer people have insurance."

The survey also asked respondents if they had ever used a prescription drug that was not prescribed to them. In that case, just 5.5 percent said yes, but nearly twice as many 18-to-29-year-olds answered yes. "These findings underscore the impact misuse of prescription pain medications is having in Kentucky and the importance of work by prescribers and policymakers to assure that these drugs aren't used inappropriately," said Susan Zepeda, chief executive officer of the Foundation for a Healthy Kentucky, which helped fund the survey.

The poll was also funded by The Health Foundation of Greater Cincinnati. It was conducted Sept. 27 to Oct. 27 by the Institute for Policy Research at the University of Cincinnati. A random sample of adults across Kentucky were interviewed, including 1,313 landline interviews and 308 cell-phone interviews. For more from the Foundation for a Healthy Kentucky, click here. (Read more)

Lawmakers grill state officials at hearing on child abuse and records of it; one says health secretary should resign

Janie Miller, secretary for the Cabinet for Health and Family Services, should resign, said one key legislator at a committee hearing yesterday. The frustration of Sen. Julie Denton (Lexington Herald-Leader photo) stemmed in part from the manner in which the cabinet has dealt with child abuse records.

"This cabinet treats everyone as an adversary," said Denton, a Republican from eastern Louisville and co-chair of the Interim Joint Health and Welfare Committee. "I'm tired of lies. I'm tried of deception. I'm tired of the tap-dance routine. I'm tried of the shroud of secrecy. We should be partners, not adversaries."

Denton spoke near the end of a committee meeting at which Pat Wilson, retiring commissioner of the Department for Community Based Services, testified about a recently released report on child fatalities and near fatalities, as well as last week's public release of child-abuse records. Miller did not attend the meeting.

The report showed 18 Kentucky children died from child abuse or neglect in the past year, but did not include the names of the victims or the case of 9-year-old Amy Dye, who died at the hands of her adoptive brother. The release of child-abuse records has likewise been controversial, with the cabinet fighting the state's two largest newspapers, The Courier-Journal and the Lexington Herald-Leader, in court for years to avoid having to do so.

Wilson said her department "wholeheartedly supports being open and being accountable," but asked legislators to consider the pitfalls of having too much information available to the public. "I've done this work, I've knocked on the doors, I've interviewed the people and I've been in the houses," she said. "Almost inevitably, the person that you're talking with, not so much the professionals but the family members, the neighbors next door, will say, 'If I tell you this, will you promise me no one ever will know I said it?' You know, up until now, (we've say yes) and that has been the hallmark of this department."

Since the release of records, Wilson said her staff has already told her "individuals are telling them, 'I don't think I want to talk to you.'" She added she worries about the safety of her staff, saying there are larger ramifications when details of near-fatalities become public in a small town or rural community. "If you can for a minute, think about how it's going to feel when you're that worker, knocking on the door of that house and you're saying to those individuals I'm here to help you," she said. "I think it's going to be very tenuous."

Wilson explained Amy Dye's case was not included in her report because she was killed by a sibling, not her custodial parent. Though the cabinet had been contacted twice by school officials who suspected Dye was being abused in the home, the suspicions had been deemed unwarranted, Wilson said. Nevertheless, records released after Dye's death "include a letter from the school nurse that lists six reports from school officials about suspected abuse or suspicious injuries to Amy," reports Beth Musgrave of the Lexington Herald-Leader. "However, only three of the reports are contained in the cabinet's file on Amy."

Before her death, three years passed in which the cabinet did not receive any complaints of Dye's well-being. "We did know her but we knew her in 2006 and 2007," Wilson said. "In 2008, 2009, 2010, there was no communication." Dye had reportedly been sent out of state in the years preceding her death, but Todd County School Supt. Michael Kenner said the school did not know what had become of her, since there was little communication with the cabinet. "We didn't even know if she was in school," he said.

Many legislators took issue with the omission of Dye from the report, with Sen. Joey Pendleton, D-Hopkinsville, asking "How many others were killed by siblings that's not in this report that we don't know about?"

Wilson said state law only requires the report to contain information about deaths or near deaths that occurred at the hands of the primary caregiver, but Rep. Susan Westrom took issue with that. "Nobody from the cabinet has ever come to us and said, 'You know what? We have a statute that is too confining. We are still not able to protect our children from even siblings. The only people we can protect them from is the caregivers, which leaves a gaping hole in the safety net.'"

Legislators also asked why the report, released earlier this month, was three months late. Wilson said she took full responsibility for the tardiness. "It wasn't what I thought it needed to be," she said. "It's late because I had to redo the report." (Read more)

Monday, December 19, 2011

Johnson County focus of C-J series on docs, prescription abuse

The second day of The Courier-Journal's investigation into prescription drug abuse and the role of doctors looks at Johnson County, ranked 11th in the state for drug overdose deaths despite its small population of 24,000. It ranks second in such deaths per capita, right behind adjoining Floyd County, as shown on this C-J map of death rates by county. (Click on map for larger version.)

In Paintsville, Johnson's county seat, three doctors have been convicted in the past 10 years of prescribing narcotics illegally. The epidemic prompted the county Fiscal Court to try to pass an ordinance that would have outlawed clinics that were "dealing largely in cash; drawing significant numbers of patients from other counties; generating at least half of their revenue from prescribing narcotics; dispensing disproportionate amount of prescriptions, compared with other medical services; and not being affiliated with a nearby hospital," R.G. Dunlop reports. Attorney General Jack Conway's office ruled the county did not have the authority to pass such a ban.

Dunlop relays the stories of the Paintsville doctors with shocking prescribing practices and also speaks to the mayor, who called the problem "an epidemic." "What we end up doing is arresting all these 'victims' ... and the doctors who create the problem continue to practice." The C-J site also includes this video of Dunlop and photographer Scott Utterback's encounter with Aaron Cantrell, a co-owner of a clinic that is pictured today and will be the focus of more coverage tomorrow. (Read more)

State medical board is soft on physicians, compared to other states and professions, and seems to be getting more lax

Though the state has a serious problem with abuse of prescription drugs, the Kentucky Board of Medical Licensure has a history of being soft on physicians with problematic prescription pill-writing practices, reinstating licenses after doctors have been convicted of felonies within Kentucky and granting licenses to doctors who have had them taken away in other states. So reports R.G. Dunlop of The Courier-Journal, whose three-day package that began yesterday highlights many instances of doctors whose medical privileges have been restored after serious run-ins with the law.
He starts with Tufan Senler, who ran a weight-loss clinic in Jefferson County and pleaded guilty to felony drug trafficking and money-laundering charges. "But in March 2010, after Senlar had been sentenced to two years' probation, the Kentucky Board of Medical Licensure restored his medical privileges — even though he still had more than six months of court-imposed home incarceration to serve," Dunlop reports.

In October, the C-J submitted questions to the board, asking it to provide information about 30 disciplinary cases, as well as its policies. "The board's written responses, received a month later, did not address most of the questions about specific cases, and ignored cases entirely," Dunlop reports.

Legislators have expressed their disapproval, with House Speaker Greg Stumbo and Attorney General Jack Conway both asking the board to make use of the state's prescription drug-monitoring system known as KASPER. Until last week, the board was against requiring doctors to use KASPER, though on Thursday agreed to support mandatory registration.

Not only has the board has been lax in tracking doctors, it has allowed physicians to practice in Kentucky when they've ran into trouble in other states. Again, Dunlop lists several examples, one of which involves Ali Sawaf. His medical privileges had been taken away at a Michigan hospital and he was convicted of tax evasion and domestic violence. In 1998, the Kentucky board granted him a license, and three years later, he was "facing a multitude of federal and state criminal charges, including the illegal prescribing of controlled substances," Dunlop reports. He was given a 20-year prison term.

Frank Rapier, who recently retired as the head of Appalachian High Intensity Drug Trafficking Areas program, said it was "ridiculous" that the board would allow doctors who were convicted or disciplined in other states to practice in Kentucky. "Why would we allow that?" he said. "An arsonist gets kicked out of one state, and you're gonna let him in yours?" In Florida, the state medical board often tells doctors who have been asked to surrender their licenses to "never" reapply. In Virginia and Ohio, a doctor can have his or her license permanently revoked. In Kentucky, they can reapply after two years in most cases.

And though Kentucky's board is lax compared to other states, it seems to be getting more lenient. "According to data compiled by a federation of licensure boards nationwide, the Kentucky board's total 'prejudicial actions,' which include the most serious sanctions it imposed, dropped from 95 in 2009 to 52 last year," Dunlop reports. "That was the fewest such actions by the board since at least 1999."

For more than 10 years, Kentucky's board has consistently been ranked by Public Citizen, a national nonprofit consumer-advocacy organization, as one of the country's best. But in 2010, it dropped to 12 place, down from third the year before. Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, called the drop "very worrisome."

Kentucky's licensing board is also more lax than other professional boards in the state. After a felony conviction, Kentucky lawyers and pharmacists can lose their licenses permanently. The pharmacy board "can also revoke a license for five years and a day, which requires the pharmacist to seek reinstatement and, at least in some instances, to retake required tests," Dunlop reports. Attorney Kent Westberry, a former federal prosecutor and president of the Kentucky Bar Association in 2004-05, said he could only remember one instance of an attorney who had been disbarred for a felony conviction getting his license reinstated.

Gov. Steve Beshear said the board has pledged "to take swifter, more decisive action against these drug-dealing doctors who are no longer practicing medicines but who are instead enabling devastating additions." Conway said he is "hopeful" the board will become part of a solution in combatting prescription drug abuse. Stumbo said he plans to propose legislation that will improve the use of KASPER and make the board take "prompt action to curtail the prescribing privileges of anyone convicted of inappropriate prescribing."

Board attorney Lloyd Vest said changes must come from the legislative level, saying that the options of permanent license revocation and longer periods before reinstatement is considered would have to be made law and "the board would certainly respond to those legislative statements." (Read more)

Beshear must reject hospital merger, C-J argues in huge editorial

Gov. Steve Beshear must say no when it comes to the merger of University Hospital, Jewish Hospital & St. Mary's HealthCare and St. Joseph Health System because it jeopardizes the separation of church and state, contends a lengthy editorial in The Courier-Journal. (C-J photo of University Hospital by John Rott)

The merger would mean the University of Louisville's hospital, a public institution, would be subject to Catholic health directives because St. Joseph is owned by Catholic Health Initiatives. "The result of merger would be that this community's public hospital, built only after voters approved a bond issue for its initial funding and with millions of taxpayer dollars flowing into it for decades, would be bartered away without public input, open bidding or any other formal procedures, to a religious group that limits standard medical care based on religious dogma," the editorial reads.

In order to take place, the merger requires the green light from Beshear, who must not give it, the editorial argues. Instead, he must remember when "he recognized the problem with posting the Ten Commandments in public school classrooms" while he was attorney general 30 years ago. "He needs to recall that brave and principled stance and tell U of L that no, you cannot sell the people's hospital to a religious organization."

The editorial, which took up the vast majority of the Sunday paper's Forum section, not the usual space on the first inside page of the section, also points out there is no other church-state medical complex anywhere else in the county because "it's unconstitutional."

The editorial also contends the merger is discriminatory. If it were to go through, women who have given birth to a baby at University Hospital would have to be taken to Baptist East Hospital if they wanted to receive a tubal ligation, a procedure that is often performed after a birth. "It is a deplorable solution to a problem that shouldn't exist to begin with," the editorial reads. "And it won't exist if Gov. Beshear has the sense and courage to reject this misbegotten scheme." (Read more)

Friday, December 16, 2011

Legislators to discuss child abuse report Monday; chilling stories emerging about abuse trends

After a wave of stories pertaining to child abuse records made front-page news this week, the Interim Joint Health and Welfare Committee will meet Monday to discuss the Cabinet for Health and Family Services' recently released report on child-abuse fatalities and near-fatalities.

The meeting will be held at 1 p.m. in room 129 of the Capitol Annex. Click here to see live video streaming of the meeting provided by KET.

This year's report was released earlier this month and showed 18 Kentucky children died from child abuse or neglect in the past year, down from 33 in 2009. But critics say the report is incomplete, just 15 pages long compared to the 29-page report last year. Terry Brooks, executive director of Kentucky Youth Advocates, called the report "a failure," saying it made it difficult to compare findings from past years. It was also three months late in being released.

On Monday, the cabinet released 86 internal reviews of cases in which children had either been killed or nearly killed from abuse, though in many instances did not release the names of the children who were affected. The records were handed over by the cabinet after years of litigation and two weeks after Gov. Steve Beshear ordered the release.

The documents show there is a lack of protocol in handling the case reviews, the Lexington Herald-Leader's Bill Estep and Beth Musgrave reported.

Another Herald-Leader analysis that ran in today's edition showed more communication is needed between doctors and social workers. Reporter Valarie Honeycutt Spears cited one instance in which a 22-month old girl came to the University of Kentucky Medical Center with hair loss and an ulcer in her mouth.

"While at the hospital, the toddler developed bruises, and she cried when her mother came into the room," she reports. On Feb. 19, the girl died, with an autopsy showing she had broken bones, multiple bruises, a detached aorta, and a laceration to the liver. Her hair had also been pulled so hard she had a large hematoma on the top of her head.

In their review, cabinet officials determined UK did not report its concerns because there had been no history of abuse. "This has already been addressed with UK, and their policies have changed as a result of this incident," the report reads.

The toddler's case is one of 14 that involved children who had died or nearly died in 2009 and 2010 "that cited a need for better communication between medical professionals and child-protection workers," Spears reports. (Read more)

Discussion on statewide smoking ban to air on KET Monday at 8

The possibility of a statewide smoking ban will be discussed on Kentucky Educational Television's "Kentucky Tonight" Monday.

The guests will be state Rep. Susan Westrom, D-Lexington; Rep. Mike Harmon, R-Junction City; Amy Barkley, tobacco-state and Mid-Atlantic officer for the Campaign for Tobacco Free Kids; and Jim Waters of the Bluegrass Institute for Public Policy Solutions.

Westrom has already said she plans to re-introduce a bill that would ban smoking in indoor public places and work facilities this upcoming legislative session. She introduced the bill last year as well, but told cn|2's "Pure Politics" it was more of a trial run to "educate" other legislators.

The results of a poll released this week show just over half of Kentuckians would support a statewide law that would ban smoking in most public places, including restaurants and bars. Just under 53 percent said they were in favor of such a law, and another 1 percent said they lean toward favoring it. Only 40.5 percent opposed the idea, with 2 percent leaning against it. Four percent had no opinion.

The show airs at 8/7 p.m. CST Monday on KET. Kentucky viewers with questions can send e-mail, including their name and town or county, to The phone number for viewer calls during the program is 1-800-494-7605. Viewers can also submit questions on Twitter to @BillKET or #kytonight, or on KET's Facebook page.

13 Kentucky schools, 11 in Perry County, receive funds and other help to get more kids eating breakfast

Thirteen Kentucky schools will receive money and other help to get more children eating breakfast at school, an undertaking funded by Kellogg's cereal company and Action for Healthy Kids. The goal is to serve 1 million more breakfasts nationwide to kids in need this school year. (Photo taken at Perry County Central High School by Larry Robinson)

Perry County's 11 schools, Bath County's Owingsville Elementary and Bellevue Independent's Grandview Elementary were among 95 schools from 26 states chosen. More than 65,000 students attend the schools, with 76 percent qualifying for free and reduced meals and 76 percent opting to eat school lunch. However, only 36 percent of those children eat breakfast at school.

In Perry County's 11 schools, which got $12,000, the funds will be used to develop a "Grab and Go" breakfast option, allowing students to eat outside of the cafeteria if they choose.

The 2010 School Breakfast Scorecard from the Food Research and Action Center showed 99 percent of Kentucky schools participated in the National School Breakfast Program in the 2009-10 school year. About 58 percent of low-income children who participated in the program also ate breakfast at school, ranking Kentucky sixth in the nation for the double enrollment. "However, if Kentucky schools boosted participation to serve 60 low-income children breakfast for every 100 low-income kids served lunch, nearly 9,000 more children would be eating a healthy school breakfast every day," says a press release by Kentucky Action for Healthy Kids.

Most women over 65 don't need annual Pap smears anymore

Many women over the age of 65 no longer need to get an annual Pap smear in order to detect cervical cancer, the American Cancer Society, the American College of Obstetricians and Gynecologists and the U.S. Preventive Services Task Force agree. For low-risk women in that age bracket, there is no additional benefit to routine yearly screening, reports Paula Span for The New York Times.

"In women who have had normal annual Pap tests for many years and are in monogamous relationships, the risk of cervical cancer is very low," said Dr. Sarah Feldman, a gynecologist oncologist at Brigham and Women's Hospital in Boston.

However, there are some exceptions. If a woman received a Pap for reasons other than a routine screening, she should continue to be tested. She should have received three normal tests in the past decade; if not, she should get a Pap whether she's over 65 or not. And a woman should still have discussions with her doctor about any problems she might be having.

Though studies show the Pap test is not necessary for women over 65, it may be difficult for women, and their doctors, to agree to stop getting it. "People have gotten comfortable with that annual Pap smear," Feldman said. "They don't want it to stop." "It's a habit that might prove difficult to break," Span reports. (Read more)

New technology at UK allows for more comprehensive breast imagery, especially for women with much dense or fatty tissue

Technology that will enable radiologists to see individual breast structures without overlapping tissues obstructing their view will begin being used at the breast care center at the University of Kentucky Markey Cancer Center. It will be the only center in the state to use the 3-D technology known as tomosynthesis.

"In addition to providing the traditional top and side images of the breasts taken during a regular mammogram, tomosynthesis also allows the technician to take multiple X-ray pictures of each breast from many angles," a UK press release said. "A computer than combines all this information into one 3-D image."

The technology is expected to be especially useful for women who have dense or fatty breast tissue. More than 50 percent of women under the age of 50 have dense tissue and more than 30 percent of women over 50 have dense tissue. (Read more)

Thursday, December 15, 2011

Calls for hospitals to reveal more about errors, infections are getting louder; feds plan more data, but hospitals fight state rules

By Tara Kaprowy
Kentucky Health News

LEXINGTON, Ky. -- The stories are hard to hear.

A little girl is taken to the hospital after she turns on the water and burns herself in the bathtub. After being admitted, her mother notices she looks dehydrated but nurses and doctors don't respond to the mother's pleas for help. A few days later, the girl dies.

While in the hospital, a father gets a gastric tube that is mistakenly inserted into his lungs. He soon passes away.

A friend goes into the hospital to get a knee replacement. He gets an infection from which he never recovers.

These scenarios are all the result of medical errors and hospital-acquired infections. The Centers for Disease Control and Prevention report nearly 100,000 Americans die each year from such infections alone. Calls for hospitals to be more transparent about what happens behind the curtain are growing more insistent, and the concern was the focus of last month's Health Watch USA conference in Lexington.

"This isn't a political issue, this is a real human issue," Rosemary Gibson, author of The Wall of Silence, a book about the problem, told those in attendance. "We need to do better here."

For the past several years, Frances Griffin, a faculty member with the Institute for Health Improvement, has been teaching hospitals how to measure harm, which IHI defines as an "unintended physical injury" that requires additional monitoring, treatment or hospitalization. "We're not getting into blame here," she said. "We just counted all the unintended consequences of medical care that required intervention."

For a study published in Health Affairs in April 2011, Griffin and her team reviewed 795 records from three large hospitals. They found 33 percent of patients experienced an adverse event, ranging from temporary harm that required intervention to an event that resulted in death. The findings were eye-opening, showing "adverse events in hospitals may be 10 times greater than previously measured," she said.

And, despite hospitals "pouring a lot of money into patient safety," Griffin said studies show that many patients are still being harmed. "We may not be applying our efforts to the right areas," she said.

Lack of transparency

Though data have been collected from hospitals around the country for many years — either through voluntary reporting or to comply with state laws — much of it has not been available to the public.

The only data on adverse events that is available now for Kentucky is based on Medicare billing claims and can be viewed at It shows numbers about urinary catheterizations, central-line infections, pressure ulcers (bedsores), falls, blood incompatibility and foreign objects left in the body after surgery. But these claims might not tell the whole story, said John Santa, director of the Health Ratings Center for Consumer Reports, because "They're not being submitted to describe what happened accurately; they're being submitted to get payment."

Starting next year, the Centers for Medicare and Medicaid will release data that are collected by the CDC's National Health Safety Network and are based on actual patient records from acute-care hospitals, including ones in Kentucky. Information will be released on central-line bloodstream infections that occur in the ICU. In 2012, hospitals will then be required to collect information about surgical-site infections and catheter-associated urinary infections, which will later be released.

"I think we have gotten to a turning point," said Dr. Kevin Kavanagh, chairman of Health Watch USA. "It's become evident that states need to be engaged in their reporting efforts so the quality of data that's reported to the federal government is as good as it can possibly be and be reflective of what's going on in the states."

In Kentucky, there are no mandatory public reporting requirements for hospitals. In fact, hospitals must only inform the Department of Public Health about infectious outbreaks, but the definition of an outbreak varies from facility to facility based on the number of patients seen in a specific period of time. Though almost 100,000 people die each year nationwide from hospital-acquired infections alone, Kentucky hospitals only reported four outbreaks between Oct. 1, 2009 and Sept. 31, 2010.

"Without data, it's hard to know where our problems are," said Fontaine Sands, who manages the Kentucky Department for Public Health's program to prevent infections associated with health care. "We don't have anything specific on Kentucky and where (problems) are occurring on different levels of care."

Still, Sands isn't necessarily pushing for a state law, which could be overly burdensome. "The thing we don't want to do is put a mandate out there that is, one, too difficult to implement, and, two, doesn't give what the consumer needs."

Hospitals fight state attempts to require reporting

State Rep. Tom Burch, chairman of the House Health and Welfare Committee, is in favor of state monitoring, but said hospitals are generally reluctant to do it. But the Louisville Democrat, who was a quality-control supervisor at General Electric Appliance Park, said "It's just good business that you put out a quality product. If you've got nothing to hide, then why not put it out there?"

Burch introduced a bill last session that would have required reporting of infections acquired in health facilities acquired infections. "I ran into a buzz saw, needless to say," Burch said. The Kentucky Hospital Association was against the bill. "We support reporting but we want a national standard," said Nancy Galvagni, senior vice president of the KHA. "The federal government has already set up a standard, and we see no reason to duplicate it."

She added that most of Kentucky's hospitals have 100 beds or less and can't afford the money it takes to track the data. "We have to be recognizing the limited resources that are out there," she said.

The two hospital systems in Kentucky that have opted to release their own data — Norton Healthcare and Saint Joseph Health System — are large ones. Norton released its data, which are updated on a monthly basis, in October 2005. The move was not without its anxieties. "The fear is: What if we report it and the other guy doesn't?" said Ben Yandell, division director of clinical information analysis for Norton.

Since it started tracking its data, Norton has improved on many measures, Yandell said. Bluegrass Oakwood in Somerset has had the same outcome, with fewer bedsores, ear infections and urinary tract infections. The numbers have improved because the tracking system has improved, Oakwood Medical Director Keith Sinclair said.

Facilities that have full-disclosure policies also tend to spend less on malpractice litigation. After the University of Michigan Health System adopted a full-disclosure policy, "There was a 50 percent drop in medical malpractice suits, a lower mortality and much better, stronger defense when there was litigation," said Helen Gulgin Bukulmez, board member and patient advocate at Health Watch USA.

But there are drawbacks to reporting, which can "lead to hiding flaws instead of tracking them," Yandell said. It also might reduce access to care if providers avoid high-risk patients in order to keep scores up and could lower the quality of care if good care conflicts with what would give a good score.

Still, there is power in knowing how a hospital is performing, Santa said, citing data that was collected by the Society of Thoracic Surgery. As part of the analysis, which looked at such measures as whether patients were getting the correct medicines, the probability of survival 30 days after bypass surgery and the probability of major complications, 10 Kentucky hospitals allowed their data to be released. At Central Baptist in Lexington, there was an 89 percent probability of avoiding complications. At Hardin Memorial Hospital in Elizabethtown, there was a 73 percent probability. "Now ask yourself," Santa said. "Who would you rather go to? Hardin Memorial or Central Baptist?"

Conway, Stumbo say Yonts' pseudoephedrine bill doesn't do enough to stop smurfing

State Rep. Brent Yonts, D-Greenville, has proposed a bill that would make people who have been convicted of meth-related crime to get a prescription to buy pseudoephedrine, but Attorney General Jack Conway and House Speaker Greg Stumbo both told cn|2's "Pure Politics" that the bill wouldn't do much to fight the problem.

"It's not enough," Conway said. "We need to prevent smurfing. We saw the number of meth labs in this state double last year." Smurfing is the use of surrogates to buy ingredients on behalf of those who might otherwise not be allowed to bu

"It's a start, but it's not enough," Stumbo said of Yonts' bill. "I mean, if they were convicted of it, chances are they would still be in jail. But that's kind of like closing the door after the fox has already gotten into the chicken house."

Pseudoephedrine is the key ingredient used to make methamphetamine and is found in many cold medicines, including Sudafed. There are limits for how much of the medicine each person can buy each month, but that has not stopped the problem, Conway say.

As for how the problem will be addressed in the upcoming legislative session, Stumbo said he thinks "The stars are lined up to where we'll have a good, comprehensive bill," but "I don't know what it's going to look like." (Read more)

Critics, proponents debate Louisville hospital merger

Questions regarding ectopic pregnancy, end-of-life care and funding for indigent care were addressed Wednesday by proponents and critics of a proposed merger between University Hospital, Jewish Hospital & St. Mary's HealthCare and St. Joseph Health System. The issues were discussed at a meeting of the Louisville Forum.

The merger, which still needs approval by Gov. Steve Beshear, would give St. Joseph majority control over the three systems. Because St. Joseph is owned by Catholic Health Initiatives, University Hospital and Jewish and St. Mary's would have to adhere to Catholic health directives.

As such, "The other merger partners have agreed not to perform certain services forbidden by those directives: elective abortions; sterilizations; contraceptive dispensing for the purpose of contraception only (except in cases of sexual assault when the victim isn't already pregnant); artificial insemination and in-vitro fertilizations; and euthanasia," reports Laura Ungar of The Courier-Journal.

Altogether, there are 72 Catholic health directives, but David Laird, president and chief executive officer of Jewish and St. Mary's, said his organization and University Hospital have not agreed to abide by all of them. "We are not a Catholic hospital," said Laird, left. "University will not become a Catholic hospital," he said. (Photo by Frankie Steele)

Merger critic Beverly Glascock, a Louisville attorney and former nurse, broached the issue of ectopic pregnancies, which occur in the fallopian tube rather than in the womb. In all cases, the fetus cannot survive and there is danger to the mother if the tube bursts.

But, in a merger document released earlier this week, one of the banned procedures includes "elective (direct) abortions." "In the case of extra-uterine pregnancy, no direct abortion will be performed," the document reads.

Dr. Dan Varga, chief medical officer for St. Joseph Health System, addressed the issue, saying "a direct abortion is the termination of a viable pregnancy, and ectopic pregnancies are, by definition, not viable," Ungar reports.

The issue of indigent care was also discussed. Since CHI has said it will invest $320 million in the deal and commit $200 million to improve University and Jewish hospitals, one audience member asked how much of that would be used for indigent care. Laird said a combined $270 million in indigent care is already being spent. As for whether the CHI funds will increase that sum, Laird said he could not say. "How much will these hundreds of millions of dollars will go to help the indigent?" Glasscock asked. "Not one dollar, not a cent."

As for end-of-life care, merger partners said they have "agreed only not to perform euthanasia, which they do now," Ungar said. Continuing to provide food to someone in a vegetative state and honoring living wills should not be a concern. (Read more) To view a video of part of the hospital merger discussion, click here.

Wednesday, December 14, 2011

Ban texting and cell phone use while driving, National Transportation Safety Board urges

States should prohibit drivers from using cell phones and other portable electronic devices while behind the wheel, except during emergencies, the National Transportation Board said Tuesday. The recommendation was unanimous among the five members of the board, who said it should apply to hands-free and hand-held phones.

"The board made the recommendation in connection with a deadly highway pileup in Missouri last year," reports Joan Lowy of The Associated Press. "The board said the initial collision in the accident near Grays Summit, Mo., was caused by the inattention of a 19-year-old pickup driver who sent or received 11 texts in 11 minutes immediately before the crash."

The crash involved the pickup, a tractor truck and two school buses. The driver of the pickup and a 15-year-old student on one of the buses were killed. Thirty-eight others were injured.

Though the board cannot impose restrictions on cell phone use, federal and state lawmakers and regulators take their recommendations very seriously.

Accidents involving texting and cell phone calls are becoming increasingly common. It has even become commonplace for investigators to immediately to look at texting records when launching an accident investigation, Lowy reports.

The board previously recommended that commercial truck drivers and bus drivers be prohibited from texting and talking on cell phones. Texting while driving is forbidden in 35 states, including Kentucky. But about 2 in 10 American drivers, and half of drivers between the ages of 21 and 24, said they have texted or sent an email message while driving, a survey from the National Highway Traffic Safety Administration found. (Read more)

Most Kentuckians now favor statewide smoking ban, poll finds

Graph shows results by smoking history, party
Just over half of Kentuckians support a statewide law that would ban smoking in most public places, including restaurants and bars, the Kentucky Health Issues Poll has found.

Just under 53 percent said they were in favor of such a law, and another 1 percent said they lean toward favoring it. Only 40.5 percent opposed the idea, with 2 percent leaning against it. Four percent had no opinion.

Including leaners, the law was favored by 53.7 percent to 42.5 percent, a double-digit margin. Last year, Kentuckians were split down the middle, 48 percent to 48 percent. The poll's error margin is plus or minus 2.44 percentage points, meaning that each figure could vary that much from actual public opinion in 19 of 20 cases. It could vary more in one out of 20.

The poll was released yesterday by the Foundation for a Healthy Kentucky. It asked 1,614 Kentuckians, "Would you favor or oppose a state law in Kentucky that would prohibit smoking in most public places, including workplaces, public buildings, offices, restaurants and bars?" The detailed results were: 40.9 percent favored strongly, 11.8 percent favored somewhat, 11.5 percent opposed somewhat and 29 percent opposed strongly.

Despite those strong views, there was again no split along party lines; 55 percent of Democrats and 55 percent of Republicans were supportive of a ban and independents were slightly less so. As was the case last year, respondents who are registered to vote were more likely to support a smoke-free law, with six in 10 in favor.

Respondents in the Lexington area showed the strongest level of support, with nearly 57 percent of people living there either strongly or somewhat in favor of passing a statewide ban.

Interestingly, respondents living in Appalachian Kentucky — which historically has very high smoking rates — also expressed strong support, with 53.4 percent in favor, plus or minus 4.96 percentage points. (The poll groups counties by area development districts; Appalachian Kentucky was defined as counties in ADDs that are mainly Appalachian, in green on the map.)

Despite Campbell County overturning its smoking ban earlier this year and controversy surrounding the ban in Kenton County, which is the only county in the region with a ban, respondents in Northern Kentucky showed the third highest level of support for a statewide law, with 52.9 percent in favor. The error margin for that small sample of 152 was plus or minus 7.95 percentage points.

In Louisville, 52.4 percent favored the law, plus or minus 5.26 percentage points. Western Kentucky had the lowest level of support, with 49.5 percent in favor and 47.1 percent opposed, plus or minus 4.63 percentage points. The poll included the Lincoln Trail Area Development District, generally recognized as part of the Louisville region, as part of Western Kentucky.

The issue is most strongly supported by non-smokers. Of respondents who have never smoked, 3 in 4 are in favor of a smoke-free law. Fifty-seven percent of respondents who are former smokers were in favor. When it came to smokers, just 3 in 10 support a law. For tables showing the detailed poll results, click here.

The poll, which was funded by the Foundation for a Healthy Kentucky and The Health Foundation of Greater Cincinnati, was conducted Sept. 27 to Oct. 27 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,614 adults across Kentucky were interviewed, including 1,313 landline interviews and 308 cell-phone interviews. For more from the Foundation for a Healthy Kentucky, click here.

University Hospital merger documents being released

The University of Louisville will hand over records pertaining to the merger involving University Hospital, under a settlement signed Tuesday.

The documents will include "the June 14 agreement to consolidate the three health-care systems into one — though without some supporting documents — and the new system's affiliation agreement with U of L," reports Patrick Howington of The Courier-Journal. The move is a victory for Jefferson County Attorney Mike O'Connell (C-J photo by Pam Spaulding), who sued U of L after merger-related documents were not provided to him upon his open- records request. Though he will not receive all the documents he wished to view, he agreed to settle because of time constraints; the merger is expected to be final by Dec. 31.

The merger involves University Hospital, Jewish Hospital & St. Mary's HealthCare and St. Joseph Health System.The records, which will be handed over by Thursday, will include "the bylaws and articles of incorporation of the still-unnamed new system and a new lease agreement for the state-owned University Hospital property," Howington reports.

A table showing the merger's benefits to U of L was given over Tuesday. It shows U of L will get a larger piece of the hospital's profits than before. "The hospital gave U of L $11 million each of the past four years, but the new company would give the university $11 million each year, adjusted for inflation, plus 24 percent of the 'excess cash' — loosely meaning profit — of the entire system," Howington reports. (Read more)

Child abuse records released, but without names of victims

Though the state on Monday released 85 internal reviews of cases in which children had either been killed or nearly killed from abuse, in many instances it did not release the names of the children who were affected. The reviews also show considerable variability in terms of how thoroughly the investigations were conducted.

The records were handed over by the Cabinet for Health and Family Services after years of litigation and two weeks after Gov. Steve Beshear ordered the release. Twice before, Franklin Circuit Judge Phillip Shepherd ordered the cabinet to turn over the documents to The Courier-Journal and the Lexington Herald-Leader, which had sued the cabinet for failing to provide the records.

But while 353 pages were handed over Monday, the names of at least eight children who died from abuse or neglect had been redacted, along with all the names of children who had been seriously injured, report Bill Estep and Beth Musgrave of the Herald-Leader. "That is totally contrary to the letter and the spirit of the judge's ruling," said Robert Houlihan Jr., a lawyer for the Herald-Leader. "Where there has been a fatality, there can be no justification that I see to redact that name of the dead victim."

The documents show there is a lack of protocol in handling the case reviews. "Some reviews are lengthy and thorough, including an analysis of what social workers could do differently to prevent similar deaths," Estep and Musgrave report. "But some internal reviews consist of one page that doesn't even say whether the child died."

"If children dying does not demand a formalized process, you have to ask yourself, what does?" said Terry Brooks, executive director of Kentucky Youth Advocates. (Read more)

Still, the records do paint some harrowing pictures, with Estep, Musgrave and Valarie Honeycutt Spears reporting Tuesday about one little boy who fell off a deck in Lincoln County while his mother and boyfriend were drunk. "There was no food in the filthy house, but there were pill bottles, beer cans and needles lying around, and blood on the child's bed," they write, noting more than half of the internal reviews show there was either involvement or suspected involvement of substance abuse. (Read more)

Regardless, the redacted documents prompted a scathing editorial in The Courier-Journal, saying "the result produced Monday afternoon is unacceptable and flies in the face of the spirit of Franklin Circuit Judge Phillip Shepherd's court orders."

The editorial also questions Beshear and his "belated" attempt to step in. "Whose cabinet is it, anyway?" it reads. "Is the governor saying one thing in public — 'Our children deserve our protection' and 'Transparency will be the new rule' and 'It's time for the balance to tip toward openness' — and another in private? How else to explain the gulf between what the judge ordered, what the cabinet lawyers said would be released, what the governor said, and what the cabinet produced on Monday? If Gov. Beshear does not approve of the cabinet's latest obfuscations, he must not only say so, he must act on that disapproval." (Read more)

Teens turning to flavored cigars

A study shows teens are dispensing with cigarettes and turning to flavored mini-cigars with fun flavors — strawberry, chocolate, vanilla — enticing to young palates. (National Cigar Museum picture) "Young smokers say these cigarette-size little cigars and cigarillos — slimmer versions of big cigars — look better and can be bought one at a time instead of spending more than $5 for a pack of cigarettes," writes Lena H. Sun of The Washington Post. "Many teens also think that they are less addictive."

After cigarettes, cigar smoking is the second most common tobacco product used by youth nationwide, according to the Centers for Disease Control and Prevention. About 14 percent of high school students smoke them (18.6 percent among boys and 8.8 percent among girls). Though the Food and Drug Administration banned flavored cigarettes in 2009, it did not apply to cigars. They are only available to adults 18 and older, but many stores in Kentucky do not ask for ID.

In many states, mini cigars are taxed less than cigarettes. Federal excise tax is about 39 cents on a pack of 20 cigarettes. The tax on cigars that are the size of cigarettes is 4 cents for a pack of 20. In Kentucky, the tax rate on a pack of 20 cigarettes is 60 cents. Other tobacco products, including cigars, are taxed 15 percent.

While more enticing and less expensive, they are just as dangerous as cigarettes. "You have the same cancer-causing chemicals but wrapped in flavors that don't let you experience the harsh sensation of cigar or tobacco use," said Donald Shell, interim director for Maryland's Center for Health Promotion, Education, Tobacco Use Prevention and Cessation. (Read more For a fact sheet on mini-cigars, on the Kentucky Cabinet for Health and Family Services' website, click here.

Monday, December 12, 2011

Writer weighs in on morning-after pill decision in provocative way, looking at both sides but ultimately saying it protects girls

Freelancer Mariam Williams writes a provocative piece in The Courier-Journal about a federal official's recent rejection of a proposal to allow girls 16 and under to obtain the morning-after pill without a prescription.

Williams speaks to girls who fall in this age group and highlights the advantages and disadvantages of the decision, which was made last week by Health and Human Services Secretary Kathleen Sebelius, despite a recommendation to the contrary by the U.S. Food and Drug Administration.

"Her decision will come at a cost to me and every other adult woman of child-bearing age," Williams writes. "It will set a precedent for every time someone wants to ignore science and embrace an ideology that not everyone else believes. Her actions will tell them that's OK, and when a pharmacist denies a grown woman's request for the morning-after pill, or when people who believe a fertilized egg is a person can't give any scientific reason for the laws they want to pass, they'll point to Kathleen Sebelius.

"But I believe you and girls younger than you are worth the danger her decision put all of us in. She did this to protect you where the adults in your life have failed you, to push you to talk to an adult if you're having sex or if you've been sexually assaulted so that you can get the information you need to be as safe as possible. So I hope you take your behavior seriously. We women do." (Read more)

Saturday, December 10, 2011

Make pseudoephedrine available only by prescription and see what effect it has on methamphetamine making, editorial argues

The 2012 General Assembly should make the cold medicine pseudoephedrine available only by prescription  to see if that curbs methamphetamine production, an editorial in the Lexington Herald-Leader argues.

The editorial notes the plan of Democratic Rep. Linda Belcher, D-Shepherdsville, to file another bill to require a prescription for pseudoephedrine, the key ingredient in meth, but with some changes. "Medicines in the form of gel caps would be excluded from the prescription requirement because it's hard to extract the precursors from gel caps," the editorial says. "Also, the requirement would sunset in three years to give everyone a chance to assess its effects and give Kentuckians a chance to adjust to the 130 cold and allergy medicines that cannot be put to use in meth labs."

Rep. Brent Yonts, D-Greenville, said recently that he wants to tackle the problem in another way,  blocking meth-related offenders from being able to buy pseudoephedrine unless they have a prescription. "Unfortunately, there's no reason to think that Yonts' bill would make a dent in methamphetamine production," the editorial reads. "Meth cookers could find plenty of 'smurfers' who have no criminal records to make the buys." (Read more)

Federal cuts, financial instability and competition leave many rural hospitals fearing the future

Many rural hospitals could be forced to close because of cuts to the Critical Access Program and the fact that, according to the National Rural Health Association, , 41 percent of critical-care hospitals are losing money, reports Jenny Gold of Kaiser Health News. This would be devastating to many rural communities, with a great impact felt by low-income and elderly residents. "A small hospital is often one of the biggest employers in a rural town, and closures 'can have an outsized economic impact,'" Eric Zimmerman, a health care lawyer and Washington lobbyist, told Gold.

More than 1,300 U.S. hospitals and nearly one in four acute-care facilities are designated as "critical access," giving them slightly higher Medicare and Medicaid reimbursements in return for limits on care they can provide. Many such hospitals like Hood Memorial, about an hour outside New Orleans, are dealing with uninsured patients, inability to collect payments from patients, and fewer funds from federal and state agencies, Gold reports. Many of these hospitals "tend to provide lower quality care" and are "less financially efficient than other facilities, according to a 2010 study published in the Journal of Health Politics, Policy and Law. Hood, for example, had $700,000 in losses last year despite the higher reimbursements. "It's a lot of variables, and all of them right now are working against us," CEO Hoppie Jones told Gold.

To prevent closures of rural hospitals and ensure "Americans in in isolated areas would still have access to health care," the federal government started the critical access program in 1997. To qualify, hospitals had to have 25 or fewer beds and be at least 35 miles away from another facility. However, states could waive the distance requirement, and many did, leaving hospitals like Hood with at least four other competing hospitals "within a 26 mile radius," Gold reports.