Community health workers help Kentuckians deal with the multitude of obstacles between them and better health

By Melissa Patrick
Kentucky Health News

BEATTYVILLE, Ky. – Fannie Callahan, a 62-year-old woman from Lee County, worked at the local nursing home for 38 years before retiring, has insurance, and pays her bills on time. But a six-day hospital stay in 2013 left her thousands of dollars in debt and wondering how to pay it and also cover her basic needs – until a co-worker told her about Kentucky Homeplace.

Samantha Bowman, CHW

Samantha Bowman, a community health worker at Homeplace, said she was able to call Fannie's bill collectors and get the debts written off or reduced, then helped her create a payment plan within her budget.

"I was in distress and really didn't know which way to turn," Callahan said. "I don't know what I would do without Kentucky Homeplace."

For more than 20 years, Kentucky Homeplace has used community health workers to get thousands of Kentuckians the services they need. Most of its clients are either at or near the poverty level, but the program is free to anyone in the 30 Eastern Kentucky counties it serves.

CHWs aren't medically trained, but come from the communities they serve and are trained patient advocates who help coordinate their clients' care, provide access to medical, social and environmental services, and deliver education on prevention and disease self- management.

Homeplace is part of the University of Kentucky's Center of Excellence in Rural Health. CERH Director Fran Feltner said preventive screening rates are higher for Homeplace clients than state and national averages "because the CHWs really work with them to make sure they get screened." The mammogram rate is 89 percent, far above the state's 58 percent and the nation's 60 percent.

Bowman said the greatest needs for her clients are medical, and she often helps them get medical supplies.

Counties served by Kentucky Homeplace are in blue

"We see those working-poor individuals or even middle-income individuals that come in here that have tried other avenues without success," she said. "They are working 40, 50, 60 hours a week, but the income is not enough for them to be able to afford to access the care they need, whether it's glasses, dentures, hearing aides, medications, or even diabetic shoes -- they can't afford to get them."

Bowman said she also helps her clients become better health consumers, noting that many leave their doctor's office without a real understanding of their diagnosis or what they need to do about it.

"The majority of them can't work through the medical system, it's too difficult. They don't understand, most of the time, even the medications they take," Bowman said.

"So Homeplace makes a huge difference in looking at the person as a whole and starting from that beginning screening to know what the person really needs. Is it that they need food? Is it that they need shelter? And then when you get those goals met, then you can talk to them about preventive care," Feltner said. "The success is that holistic approach that we take to take care of the people."

CHW and similar programs vary across the state

The Montgomery County Health Department's CHW program, called "The Bridge" (or "El Puente" for Latino clients) is clinic-based and focuses on chronic-disease management.

Gina Brien, director of the agency's Community Department, said surveys of clients show that they are more able to manage their at-risk or chronic conditions, have better health status and have reduced emergency-room visits and overnight hospital stays.

The Barren River District Health Department uses CHWs and registered nurses in a "self-management program" and only accepts clients who have heart failure, diabetes and chronic obstructive pulmonary disease.

Cara Castleberry, manager of the Community Health Management Program, said one of its program's many successes in the past year has been an average drop of 2.15 percent in their patients' A1C, a test for blood sugar.

The Mountain Comprehensive Health Corp. in Whitesburg uses registered nurses as quality care managers to coordinate care and improve patients' health behaviors. The program requires patients to have two chronic health conditions and is covered by Medicaid. Care managers provide many of the same services as CHWs, but are also able to manage their patients' health conditions.

"We've seen A1Cs go down. We've seen patients who never come in for preventive exams who have come in for preventives. I had a patient who hadn't had a pap[smear for cervical cancer] in 15 years . . . and she was just too scared to talk to somebody about the fact that she was afraid that she couldn't step up on that bed," said manager Chalena Williams.

Most CHW programs in Kentucky are rural, but the Louisville Urban League recently launched a CHW program, "It Starts with Me," in four neighborhoods in west Louisville, which have some of the greatest health disparities in the city.

"What we are finding with many of our clients is that there is a gap between what a medical provider -- or really any type of organization that they are interfacing with -- is asking them to do and then what they are understanding," said Lyndon Pryor, the league's health program manager.

Pryor said providers think they are being straightforward about recommending medications, but fail to realize patients don't know how to get them through their insurance, or don't have transportation to get to the pharmacy, or that work conflicts keep them from complying with the instructions.

"CHWs are able to sift through all of the different nuances of a person's life and figure out how to get to the best solution possible for the individual," Pryor said.

The future of CHWs in Kentucky

CHWs are becoming an integral part of a health system that is increasingly focused on outcomes and the social determinants of health.

Kentucky's CHW Workgroup, led by the state Department for Public Health, and the state's Community Health Worker Association are working on a certification process for CHWs, in hopes of increasing funding options, which would allow the program to expand.

Insurance rarely covers CHW services. Kentucky's CHW programs are funded by various sources, including the state's general fund, grants and local taxes.

Brien, a member of the workgroup, said it started meeting in 2012 and made progress, but last year's change in administrations has required them to educate the new health officials. Nationally, a formal task force is working on a framework for sustainable, effective CHW programs.

The Bureau of Labor Statistics says Kentucky had between 390 and 560 CHWs in May 2015, the latest data available. Nationally, there were about 48,000.

Feltner said Kentucky needs more CHW programs because there are areas all over the state with great health disparities that would benefit from them: "If you don't remove those barriers and those social determinants of health, you have a sick population."

This article was produced as part of the Health Care Workforce Media Fellowship, run by the Center for Health, Media & Policy, New York, N.Y. The fellowship is supported by a grant from the Johnson & Johnson Foundation. Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Medicare cuts 11 Ky. hospitals for patient-safety issues; repeaters in Louisville, Danville, Hopkinsville, Lexington, Paducah, Florence

The federal government is penalizing 11 Kentucky hospitals for falling short on patient safety in the fiscal year that ended Sept. 30, two more than last year.

Medicare has imposed a 1 percent cut in payments to 769 U.S. hospitals that have high rates of potentially avoidable infections and complications such as blood clots, bedsores and falls. "The reductions apply not only to patient stays but also will reduce the amount of money hospitals get to teach medical residents and care for low-income people," Kaiser Health News reports.

This is the third year of the Hospital-Acquired Conditions Reduction Program, created by the 2010 health reform law, but the first year that "the spread of antibiotic-resistant germs" has figured in the assessment, Kaiser notes. The federal Agency for Healthcare Research and Quality "estimates there were 3.8 million hospital injuries last year, which translates to 115 injuries during every 1,000 patient hospital stays."

The many rural hospitals that are designated "critical access" are not subject to the penalties. Neither are "specialized hospitals, such as those that treat psychiatric patients, veterans and children," Rau notes.

"Of the remaining hospitals, the Affordable Care Act requires that Medicare penalize the 25 percent that perform the worst on these measures, even if they have reduced infection rates from previous years," Rau reports. The list of penalized hospitals is at http://khn.org/Njg1NzMw; it's also available as a PDF or in a sortable Excel file.

University Hospital and Jewish Hospital & St. Mary's Healthcare, both in Louisville and part of KentuckyOne Health, are on the penalty list for the third straight year.

Ephraim McDowell Regional Medical Center in Danville and Jennie Stuart Medical Center in Hopkinsville were penalized last year and are also on the list this year.

Harrison Memorial Hospital in Cynthiana, St. Elizabeth Fort Thomas and Baptist Health Paducah are being penalized for the first time. Nationally, "40 percent of the hospitals penalized this year escaped punishment in the first two years," Kaiser reports.

The University of Kentucky hospital, Lourdes Hospital in Paducah and St. Elizabeth Florence, which were penalized two years ago but not last year, are on this year's penalty list.

Hospitals that were penalized last year but are NOT being penalized this year are Georgetown Community Hospital, Muhlenberg Community Hospital in Greenville; Rockcastle Regional Hospital and Respiratory Care in Mount Vernon; Saint Joseph East in Lexington; and Taylor Regional Hospital in Campbellsville.

Substance-use treatment under Medicaid jumps, following expansion of program and increase in abuse of painkillers

Kentucky's expanded Medicaid program covered approximately 11,000 substance-use treatment services in the second quarter of 2016, a huge increase from the 1,500 services from January through March 2014, the first quarter that Medicaid was expanded under federal health reform.

So says a report from the Foundation for a Healthy Kentucky, which suggests that the expansion, "as well as other elements in the health law, have helped increase access to substance use treatment in the state," the foundation said in a press release. "But rising Kentucky rates of prescription opioid and heroin abuse are also likely to have played a role in the growth of several types of treatment for substance use."

The Patient Protection and Affordable Care Act "required most health insurance plans to cover substance use treatment . . . helping ensure that more people with drug and alcohol disorders have access to the treatment they need," said Ben Chandler, president and CEO of the foundation. "But expanded access to treatment is just one part of the solution to the growing problem of opioid abuse in Kentucky and across the nation."

The report, Substance Use and the ACA in Kentucky, is the latest from the foundation's continuing study of the reform law's impact in the state. "Kentucky was one of the earliest and hardest-hit states in the national opioid epidemic, and the report confirms that the problem continues to grow in the commonwealth, the release says.

"While overall inpatient admissions for substance-use treatment in 2015 (19,005) were down from 2005 (22,705), heroin and other opioids accounted for nearly half (46.2 percent) of those admissions in 2015, compared to just 11.6 percent in 2005." Also, "Doses of buprenorphine, a medication that doctors can prescribe as part of treatment for opioid addiction, rose from 2 million in the first quarter of 2013 to 3.5 million in the second quarter of 2016."

Prescriptions for hydrocodone, the most commonly prescribed painkiller, are declining in Kentucky, but the state has seen an increase in deaths related to heroin. The federal Centers for Disease Control and Prevention recently released data that showed heroin-related deaths in the nation were 20 percent more numerous in 2015 than in 2014.

"Research has found that people often progress from using prescription opioids to heroin because it provides stronger effects, is often less expensive than prescription opioids, and may sometimes be more readily available," the report says. "The move to heroin also may be a response to efforts to make prescription painkillers harder to obtain and abuse," the release says.

"Medicaid expansion has been particularly important to young adults, who have both the highest rates of substance use, as well as the highest rates of uninsurance," Chandler said. "Since the state expanded Medicaid coverage to those with incomes up to 138 percent of the poverty level, more than 100,000 Kentuckians ages 18 to 25 have gained coverage that includes substance-use treatment services." He noted that Gov. Matt Bevin's plan to reform Medicaid would keep the coverage.

A copy of the report is available here. Other reports from the foundation's study of Obamacare's impact in Kentucky are available here.

Kentucky likely to get measures to restrict malpractice lawsuits

The coming Republican control of state government makes it likely that doctors and other health-care providers will get from the General Assembly what they have wanted for more than 30 years: legislation to limit non-economic damages in malpractice lawsuits. But the voters will have the final say, because the measure will require changing the state constitution.

Meanwhile, the legislature and Gov. Matt Bevin can, on their own, enact a law requiring such lawsuits to be evaluated by a screening panel. "The plaintiff and defendant would each nominate one doctor, and those doctors would select a third. The panel would hear evidence, then issue an opinion on whether negligence occurred and if it did, whether it caused the patient’s injuries. Regardless of the finding, the plaintiff could still file suit and proceed to trial, but the panel’s finding would be admissible," Andrew Wolfson writes for The Courier-Journal. "Peer-reviewed university studies, including one in the Journal of Legal Medicine, have found that screening panels have not reduced the number of claims, litigation costs or malpractice insurance premiums, while they have caused protracted delays," Wolfson reports.

Any broader measure to limit damages would require a constitutional amendment because the 1891 Constitution says legislators “shall have no power to limit the amount to be recovered for injuries resulting in death, or for injuries to person or property.”

"Supporters of tort reform, like Louisville emergency room Dr. Robert Couch, say “sky-is-the-limit” liability forces physicians to order unnecessary tests and procedures and that eliminating such defensive medicine would reduce health care costs," Wolfson reports. "He also said the fact Kentucky is surrounded by states that have all enacted damage caps and other restrictions makes it harder to recruit doctors to the commonwealth."

On the other hand, "Opponents say reducing liability could increase costly medical errors, lowering the quality of care and increasing costs," Wolfson writes. "Experts say that medical malpractice costs account for such a minuscule amount of the nation’s total health-care bill – only 2 percent by some estimates – that reforms have virtually no impact on the bottom line for patients."

Generally, Wolfson notes, studies show caps and other malpractice changes reduce insurance premiums for doctors by 23 to 31 percent, researchers at the University of Alabama at Birmingham’s Center for Health Policy have written, “Legislators should consider whether they benefit consumers enough to justify limiting recoveries for those most seriously injured by malpractice.”

Wolfson starts his article with the story of an Indiana insurance lobbyist who helped win a law there limiting damages to $500,000 and eliminating any damages for pain and suffering: "Fourteen years later, as the victim of malpractice during and after routine knee surgery, he was left wheelchair-bound and tethered to a respirator and a morphine drip." In 2006 he wrote an article for The New York Times titled "Crushed by My Own Reform," saying damage caps "remove the only effective deterrent to negligent medical care."

Any malpractice-tort crisis in Kentucky "seems to have abated, as medical malpractice claims have abated across the U.S., including in Kentucky, according to the National Practitioners Data Bank, to which all claims must be reported," Wolfson writes. "The amount paid on medical malpractice claims in Kentucky, including cases that were settled, declined $20 million in inflation-adjusted dollars from 2005 to 2015, according to the Data Bank, while the number of claims paid in 2015 declined to 134 from 150 five years earlier. Only 1 percent of 1,667 claims from 2005 to 2015 were for $2 million or more, and only 5 percent were for $1 million to $2 million. Medical and insurance groups note the figures only include claims that were paid, not ones in which doctors prevail, which still cost money to defend."

Anecdotal reports suggest that injured teen athletes who are prescribed opioids are getting addicted, but research is conflicted

By Melissa Patrick
Kentucky Health News

Three high-school athletes, two playing football and one a swimmer, recently told NBC News how they got hooked on opioids after being prescribed them for sports injuries. The news story warned parents to ask questions before allowing their children to be prescribed opioids.

John Haskell was one of those teens. He said at age 15 he was prescribed a powerful painkiller after his fourth concussion playing football to treat his excruciating headache.

"He looked in my ears, checked my hearing, checked my eyes. And the next thing I know, I'm at CVS getting Vicodin," Haskell told Jenna Bush Hager and Aliza Nadi of NBC News.

After going through his third refill of Vicodin, Haskell said he started buying it illegally, but eventually switched to heroin because it was cheaper.

A health expert encouraged parents to talk to their doctors about alternative treatments to opioids.

"As a parent, you need to take a more advocating role and ask your provider why are they going this route," Dr. Harold Shinitzky, a sports psychologist, told NBC. "Why is it automatically an opioid or a painkiller?"

After going through treatment, Haskell, now 18, is sober, as are the other two teens in the video.

What the research says

While a study published in Pediatrics released earlier this year found that teen athletes are less likely to abuse prescription painkillers than those who don't play sports or exercise, other research, published in the American Journal of Public Health, says that teen athletes participating in high-injury sports have a 50 percent higher odds of doing so.

Philip Veliz ,the lead author of both studies said that while anecdotal evidence that prescribing opioids to teens after a sports injury is leading some of them to becoming heroin addicts, current research does not support this claim, James Bernstein of HealthDay News reports.

Bernstein writes, "Veliz said, no large-scale studies have assessed whether abuse of recommended painkillers is actually leading to an "epidemic" of heroin use among teens who frequently engage in sports and exercise. On the contrary, this new study suggests there may be "positive social connections embedded in sports that can deter youth from serious types of illicit substance use," such as heroin or cocaine."

However, Veliz also noted that more research is needed to determine why some intense contact sports, like football and wrestling, place teens "at greater risk" for painkiller abuse,

The 2015 Youth Behavior Risk Behavior Survey found that almost 13 percent of Kentucky's high school students said they have ever taken a prescription drug without a doctor's prescription. Nationally, that number is closer to 17 percent.

1/3 of long-term prescription opioid users say they're addicted

One-third of long-term opioid users in the U.S. report being addicted or dependent on the painkillers, and nearly all of the long-term users in the survey said they got their prescription from a doctor, according to a recent survey.

But despite this high rate of dependence, 57 percent of the long-term users in the survey said the painkillers have improved their quality of life. One in six, 16 percent, said the drugs have made it worse.

Doctors in the U.S. wrote 240 million prescriptions for opiates in 2014, enough for every adult to have his or her own bottle of pills. Stateline reported in March that Kentucky ranks fourth nationally in painkiller prescriptions, at about 130 prescriptions for every 100 people. The federal Centers for Disease Control and Prevention reports that about 2 million Americans are addicted to prescription opioids.

Data for The Washington Post and Kaiser Family Foundation's Survey of Long-Term Prescription Painkiller Users and Their Household Members came from adults 18 and older who had used a prescription painkiller for at least two months or more at some time in the past two years, other than to treat pain from cancer or terminal illness.

The news release says only 5 percent of U.S. adults are long-term opioid users, and most long-term users have significant health issues; seven in 10 of them report they have a debilitating disability or chronic disease. An estimated 100 million Americans live in chronic pain, says the release.

While almost all long-term users said they took the painkillers for pain, one-third said they took them "for fun or to get high;" one in five said they took them "to deal with day-to-day stress;" and one in 10 said they took them "to relax or relieve tension." Only 3 percent of long-term users in the survey said they started taking them for recreational reasons.

Others reported misuse of their painkillers, with 20 percent of them knowing or suspecting someone was using, taking or selling their drugs; 17 percent report taking painkillers not prescribed for them; and 14 percent saying they’ve shared the drugs with a family member or friend.

The majority of long-term users in the survey said their doctor talked to them about the possibility of addiction or dependence, avoiding alcohol and other medications and other ways to manage pain., but 61 percent said there was no discussion or plan for getting off them.

In March, for the first time ever, the CDC issued guidelines for prescribing opioids. They encourage doctors to limit the length of opioid prescriptions to three to seven days, to use the lowest possible effective dosage, to monitor patients closely, and to clearly tell the the risks of addiction.

Two-thirds of the long-term users in the survey said these guidelines were concerning and will make it harder for them to obtain their medications.

“We’re not saying that no one should ever be on these pills,” CDC Director Tom Frieden told The Washington Post, but most people would be “healthier and more functional if they were off them.”

Report again ranks Kentucky 49th in well-being for seniors

Kentucky held onto its 49th spot for the seventh year in a row in a new ranking of seniors' well-being, with West Virginia following close behind.

The rankings are part of the Gallup-Healthways State of American Well-Being series that examines the well-being of Americans ages 55 and older. The analysis ranks states according to five different measures of well-being and then takes the overall score and ranks them. The state's "well-being index score" is calculated on a scale of 0 to 100, with 100 being the best.

Graphic from the State Well-Being Rankings for Older Americans report

For the second year in a row, Hawaii had the best well-being score, at 67, compared with Kentucky's score of 61.2. West Virginia, with a score of 59.9, ranked last for the second consecutive year.

Data for the report came from both cellphone and landline interviews with almost 116,000 older Americans. The survey was conducted in 2015 and the first quarter of 2016.

The well-being index measures five elements of well-being. Kentucky's older adults ranked 48th in the category that measured motivation, goals and contentment; 46th for the category that asked about relationships and love; 41st for financial stress and security category; 49th for the category that measured health and energy levels; and 40th for community safety and pride.

James Kimbrough, president of AARP Kentucky and former chief planner for the state health department, told Darla Carter of The Courier-Journal that he thought the problem was rooted in poor eating habits and a lack of physical activity and said he would like to see state's legislative leaders be public role models in these areas.

"The healthiest states in the country have a culture of encouraging people to exercise, to be outdoors, to not sit in front of the TVs," he said.

Earlier this year, the 2016 Senior America's Health Rankings Report also placed Kentucky near the bottom, ranking it 45th, which was a three-spot improvement from the previous year. This detailed report ranked Kentucky last in health outcomes and 44th in determiners of those outcomes.

Study finds a community awareness campaign increased uptake of low-dose CT scan, which can detect lung cancer early

A community awareness campaign in Eastern Kentucky about a low-dose CT scan that detects lung cancer early has increased uptake of the procedure and prompted individuals to consider quitting tobacco, says a University of Kentucky news release.

Researchers in UK's Department of Family and Community Medicine and College of Public Health developed the campaign to educate patients and health-care providers about early cancer detection through a low-dose computed tomography (LDCT) scan, which is the latest recommendation for people who have a high risk of getting lung cancer.

A low-dose CT scan is recommended for people aged 55 to 77 who are either current smokers, have quit smoking within the last 15 years or who have smoked at least a pack a day for 30 years, or the equivalent. These scans reduce lung cancer deaths by 20 percent, says the release.

Lung cancer is especially deadly because it often doesn't cause symptoms until it's too late. It is the leading cause of death in the U.S. and is expected to kill 158,000 Americans this year alone, according to the American Lung Association.

Kentucky has the highest smoking rate in the nation, 25.9 percent. It has the highest rate of lung cancer (93.4 per 100,000) and the highest death rate from it (69.5 per 100,000) in the nation, according to the federal Centers for Disease Control and Prevention. In Kentucky, these rates are highest in the Appalachian region of the state.

The "Terminate Lung Cancer" campaign focused on two high-need Eastern Kentucky regions.

Researchers worked to align the efforts of community health workers, local health agencies and regional hospitals. They provided more than 54,000 residents in the targeted regions with information about the procedure that encouraged them to talk about it with their health care provider. They also told health care providers in the targeted areas about the new guidelines, what the procedure entailed, and that the Centers for Medicare and Medicaid will pay for the scan.

To analyze the impact of the campaign, researchers collected survey data and records from three partner hospitals to analyze changes in behaviors and monthly totals of chest low-dose CT scans for malignancies.

The study, published in Cancer Epidemiology, found the people who received campaign materials reported higher uptake and awareness of low-dose CT scans than the control region population.

"It can take several years before screening guidelines reach the people who need these health services the most,” Dr. Roberto Cardarelli, principal investigator and chief of the Division of Community Medicine, said in the news release. “We wanted to know whether a population-based campaign that emphasized community engagement would reduce a knowledge gap limiting patients from receiving screening and detecting cancer early. Our results support this approach, showing an effective strategy for addressing the knowledge gap about LDCT in high-risk populations.”

Ky. had biggest drop in uninsured low-income people, and in percentage of adults who passed up care because of cost

Kentucky had the largest drop in low-income, working-age people without health insurance, and the biggest decline in adults who passed up medical care due to cost, after the state embraced the Patient Protection and Affordable Care Act.

Those two findings were the Kentucky highlights of the latest Commonwealth Fund report on the impacts of the 2010 health-reform law, released Dec. 20.

The report says the uninsured rate for low-income adults in Kentucky fell 25 percentage points, from 38 percent in 2013 to 13 percent in 2015, following the state's expansion of Medicaid under the law in 2014. Nationally, the uninsured rate for low-income adults dropped from 38 percent to 25 percent during the two-year span.

“I think this proves again what we already knew – that Kentucky has been a national model in getting folks covered,” Emily Beauregard, executive director of Kentucky Voices for Health, told Laura Ungar of The Courier-Journal.

The uninsured rate for all working-aged adults in Kentucky, regardless of income, dropped from 21 percent in 2013 to 8 percent in 2015.

The report looked at dental visits and out-of-pocket health spending relative to income to measure how states compare on access to health care. Nationally, Kentucky ranked 18th for this measure, moving up 10 spots from last year’s rankings -- the largest gain in the nation.

Kentucky also improved more than any other state in the share of adults who said they went without health care because of cost. That measure dropped to 12 percent in 2015 from 19 percent in 2013. Among low-income Kentuckians, it dropped from 34 percent to 21 percent.

Kentucky is one of the states that expanded Medicaid to allow coverage to those who earn up to 138 percent of the federal poverty level. That has added about 440,000 Kentuckians to the Medicaid rolls, which now include more than a fourth of the state's population. Under Obamacare, the federal government is paying the full cost through the end of this year. The state will have to start paying 5 percent of the cost Jan. 1, rising in annual steps to the reform law's limit of 10 percent by 2020.

The state's share of the cost is not financially sustainable, argues Republican Gov. Matt Bevin, who has asked federal officials to approve a Medicaid plan that largely targets "able-bodied adults" who qualify for Medicaid under the expansion. The plan includes co-pays, premiums, health savings accounts and work and volunteer requirements for those who aren't primary caregivers. Critics of the plan say it is too complicated and creates barriers to health care.

Doug Hogan, a spokesman for the state Cabinet for Health and Family Services, told Ungar that it’s misleading to look at the uninsured rate without additional context, noting that the number of people who had private health insurance is about the same as it was before the ACA. “What we saw was an unsustainable growth of 68 percent in the state’s Medicaid program,” he said.

Beauregard argued that scaling back the Medicaid expansion and repealing the ACA, as President-elect Donald Trump and other Republicans have vowed to do, is a bad decision for Kentucky, noting that Kentucky is one of the poorest and unhealthiest states in the country.

“The gains that we’ve made are at risk,” she told Ungar, adding that charity and uncompensated care at hospitals will go up if people lose their health insurance. “There will be real consequences for the entire state of Kentucky.”

Hogan pointed out that simply having Medicaid doesn't improve health outcomes, and said Bevin's new plan is sustainable and "will improve the health of our citizens and encourage self-sufficiency." He added, "We owe it to our citizens to do more than simply enroll people in social welfare."

Fewer teens are using drugs and alcohol than their counterparts did in the 1990s, nationwide and also in Kentucky

By Melissa Patrick
Kentucky Health News

A new national study shows teen drug and alcohol use are at their lowest rates since the 1990s, a trend that is also seen in Kentucky's teens.

Graphic from The Washington Post

The national survey of about 50,000 high school students found that “considerably fewer teens reported using any illicit drug other than marijuana in the prior 12 months — 5 percent, 10 percent and 14 percent in grades 8, 10 and 12, respectively — than at any time since 1991," says the news release.

The findings come from the annual University of Michigan Monitoring the Future survey, which tracks substance use trends among students in 12th, 10th and 8th grades. It is funded by the National Institute on Drug Abuse.

Teen alcohol and cigarette use are also at historic lows. Overall, of the students surveyed in the 2016 national survey, almost 37 percent had drank alcohol in the previous year, compared to the high of 67 percent in 1991.

And though the measures aren't exactly the same, the every-other-year Youth Risk Behavior Survey shows the percentage of Kentucky's high school students who have ever drank alcohol is also decreasing, from 78.4 percent in 1997 to almost 56.8 percent in 2015. This also held true for 8th graders, dropping from 44.3 percent in 2009, the earliest data available, to 33.5 percent in 2015.

These drops also hold true for cigarette use. In 1991, 63 percent of 12th graders in the national survey had smoked cigarettes at some point in their lifetimes, dropping to 28 percent in 2016.

The YRBS reports higher numbers for Kentucky's teens in this measure, but like the national numbers they are trending down -- from 78.9 percent of 12th graders reporting that they had ever smoked cigarettes in 1997, the earliest data available for this measure, to 49.5 percent in 2015. Eighth graders who have ever smoked cigarettes also dropped, from 47.2 percent in 2009 to 29.8 percent in 2015.

And though the national survey found teen use of electronic cigarettes had declined for the first time since researchers began tracking it in 2011, e-cigs remain more popular than traditional cigarettes, having increased 900 percent in use among youth in the past five years. This has prompted the surgeon general to issue a report that calls for a "crackdown on the devices," according to HealthDay News.

“We know enough right now to say that youth and young adults should not be using e-cigarettes or any other tobacco product, for that matter,” Surgeon General Vivek H. Murthy told The Washington Post. “The key bottom line here is that the science tells us the use of nicotine-containing products by youth, including e-cigarettes, is unsafe.”

"From 2015 to 2016, the percentage of adolescents who vaped in the last 30 days declined from 16 percent to 13 percent among 12th ­grade students, from 14 percent to 11 percent among 10th ­grade students, and from 8 percent to 6 percent among 8th grade students,” researchers said in a separate news release. “Each of these declines was statistically significant.”

Kentucky's YRBS started tracking teen use of vapor products in 2015 and found that 41.7 percent of the state's high school students had ever used an electronic vapor product, with 23.4 percent of them reporting they had vaped in the last 30 days, considered current users. For comparison to the national data, 26 percent of Kentucky's 12th graders had vaped in the 30 days prior to the survey, almost 19 percent of 10th graders; and 15.5 percent of 8th graders.

graphic from U.S. News

As states slowly begin to legalize the medicinal and recreational use of marijuana, use of the drug among teens continues to be a concern, though the national report found that since 2013 the rates have been trending down.

The survey found that marijuana use in the past year declined among 8th and 10th graders, but remained consistent among 12th graders, with 9.4 percent of 8th graders, 24 percent of 10th graders and 36 percent of 12th graders reporting they had used marijuana in the past year. Combined, the survey found that marijuana use started to decline in 2013, when the rate was almost 26 percent. The current overall rate is almost 23 percent.

This trend could not be explained by Dr. Nora Volkow of the National Institute on Drug Abuse. She told U.S. News. "“We had predicted based on the changes in legalization, culture in the U.S. as well as decreasing perceptions among teenagers that marijuana was harmful that [accessibility and use] would go up. But it hasn’t gone up."

In Kentucky, the YRBS didn't see much change in the state's high school student who had ever used marijuana between 2013 and 2015, 34 percent and 33.1 percent respectively. Nor did it see any real decrease in those who reported having used marijuana 30 days prior to the survey between 2013 and 2015, 17.7 percent and 17.2 percent respectively. However, 8th grade students who reported ever using marijuana dropped from 16.8 percent in 2013 to 13.3 percent in 2015.

“Every time a state considers rolling back marijuana prohibition, opponents predict it will result in more teen use,” said Mason Tvert of the Marijuana Policy Project, a legalization advocacy group, told The Washington Post in a statement “Yet the data seems to tell a very different story. There has been a sea change in state marijuana laws over the past six years and teen usage rates have remained stable and even gone down in some cases.”

Surgeon general calls youth e-cigarette use a public health threat

image Campaign for Tobacco-Free Kids

The Office of the U.S. Surgeon General issued its first report on electronic cigarettes Dec. 8, calling them a "major public health concern" for youth. Surgeon General Vivek Murthy also announced an interactive website with information and resources for parents and youth.

 "E-cigarettes went from being rare in 2010 to now being the most common tobacco product used by our nation's youth," Murthy said during a news conference, HealthDay News reports. "This represents a staggering development in a relatively short period of time. It also threatens 50 years of hard-fought progress we have made curbing tobacco use, and it places a whole new generation at risk for addiction to nicotine."

E-cigarette use more than tripled since 2011 among middle and high school students, with more than 3 million of them current users (past 30-day use) in 2015, says the report. And after a period of relative stability from 2011 to 2013, vaping more than doubled from 2013 to 2014 among young adults between 18 and 24 years old.

In Kentucky, 41.7 percent of high school students  have ever used an electronic vapor product and 23.4 percent reported being current users ( past 30-day use) in 2015, the first year this data was collected in Kentucky on the Youth Risk Behavior Survey. As for cigarettes, 44.1 percent had ever tried cigarette smoking and 16.9 percent were current smokers.

The 2016 Monitoring the Future survey released after this report on Dec. 13 found for the first time since they started measuring e-cigarette usage, the rate "declined significantly" from 2015 to 2016, dropping from 16.3 percent to 12.5 percent among 12th graders.

"This is a promising turnaround after several surveys found a rapid rise in youth use of e-cigarettes in recent years. However, youth e-cigarette use remains disturbingly high and exceeds use of conventional cigarettes. As the Surgeon General’s report released last week concluded, e-cigarettes pose a serious threat to the health of young people," Matthew L. Myers, president of Campaign for Tobacco-Free Kids, said in a statement.

The surgeon general's report notes the dangers of nicotine on teen and young adult brains, saying it can cause addiction, reduced impulse control, deficits in attention and learning and mood disorders.

"Compared with older adults, the brain of youth and young adults is more vulnerable to the negative consequences of nicotine exposure," Murthy said in the report.

Murthy dismissed industry claims the e-cigarettes prevent youth from becoming smokers, noting the strong association between the use of tobacco products and e-cigarettes. The report says that in 2015, 58.8 percent of high school students used both combustible tobacco products and e-cigarettes.

"There is actually no evidence to support this claim when you look closely at the data," Murthy told HealthDay News.

The report raised concerns about the potential health risks from chemicals found in e-cigarette liquids, which are heated in the device to create a vapor that users inhale. It also notes that e-cigarette aerosol is not harmless 'water vapor," though it also recognizes that it has fewer toxicants than a traditional tobacco product, and that the liquids in them "can cause acute toxicity and possibly death" if consumed.

The report says that students in the 8th, 10th and 12th grades are choosing e-cigarettes over tobacco cigarettes. "In 2015, almost 7 percent of 8th graders exclusively used e-cigarettes during the previous month, alongside 10.4 percent of 10th and 12th graders. Meanwhile, conventional cigarette use occurred in 1.4 percent, just over 2 percent and slightly more than 5 percent of 8th, 10th and 12th graders, respectively," HealthDay reports.

image from the Surgeon General report

Murthy said: "The e-cigarette industry is enticing teens to try their products by flavoring the vapor to taste like candy and fruit, and by using advertising strategies that focus on celebrity endorsements, sponsorship of sports and music events, along with themes of rebellion and sex."

The report concludes with a call to action, including incorporating e-cigarettes in to all smoke-free policies; educating parents, teachers and teens about their danger; to implement and enforce regulations to decrease youth smoking; and to strengthen regulations around advertisements that appeal to youth. It also calls for more research.

In a different statement, Myers calls for the current regulations on e-cigarettes to be strengthened by prohibiting flavors and marketing that appeal to youth, while noting there is a pending proposal in Congress that would weaken the current regulation, adding: "Research has found that more than 85 percent of current youth e-cigarette users use flavored e-cigarettes, and flavors are the leading reason for youth use."

The FDA issued some long-awaited regulations on e-cigarettes earlier this year that ban e-cigarette sales to minors and require makers of the devices to submit their ingredients, among other things. But the regulation did not address the use of flavorings or advertising.

"Federal, state and local policymakers must heed this call from the Surgeon General to protect our children from becoming the next generation hooked on tobacco," American Lung Association National President and CEO Harold Wimmer said in a statement.

Be careful in cold weather, which makes heart attacks, strokes and blood clots more likely; also, watch out for holiday stress

Heart attacks are 30 percent more likely during winter because of the weather, but there are precautions you can take to reduce your risk.

“The winter months can put even a healthy person at risk for a heart attack or other heart health problems,” said Dr. Suresh Sharma of KentuckyOne Health Cardiology Associates in Lexington. “To help protect yourself and those around you, be aware of the warning signs of heart attack, which include pressure, tightness or pain in the chest or arms, nausea, shortness of breath, cold sweat, lightheadedness and fatigue.”

Very cold weather can increase heart rate and blood pressure, and cause blood vessels to narrow, requiring more pressure to force blood through narrowed veins and arteries, increasing your risk of having a heart attack or stroke.

Shoveling snow can be risky.

Shoveling snow or exercising in the cold can also cause blood vessels to narrow and raise blood pressure. "Your heart also has to work much harder to keep your body warm in the cold," a KentuckyOne news release says. "With heart rate and blood pressure already elevated due to the low temperatures, this can cause blood clots to form and provoke coronary artery spasms. . . . When shoveling snow or exercising outdoors, remember to dress warmly to keep your blood flowing, and warm up your muscles prior to doing physical activity. Do not drink alcohol before or immediately after shoveling snow, as this can increase your risk for heart attack."

Stress related to the holidays "can also lead to heart problems," the release says. "People who display symptoms of heart-related illnesses might delay getting treatment because they don’t want to disrupt holiday festivities. Or, holiday travelers might take longer to find medical care away from home, which heightens the risk.

"Overindulgence during the holidays can also put your heart in danger. At family gatherings and holiday parties, people tend to consume alcohol and eat more than usual, including unhealthy foods that are high in sodium. Busy schedules due to holiday engagements cause people to neglect their exercise routines, which can put even more strain on the heart."

Sharma says, “Many people let their health take a backseat during the winter, but it’s actually even more important to ensure your heart is healthy during the colder months. Try to maintain a healthy lifestyle throughout the holiday season, and talk to your primary care provider about ways to protect your heart during the colder months.”

The release says, "If you or someone near you is presenting symptoms of a heart attack, call 911 immediately. Then, if you are able, perform hands-only CPR by placing your hands on the victim’s chest and administering compressions hard and fast, 100 times per minute, in the center of the chest. Don’t stop until help arrives." For more about heart-disease risk factors, or to take a heart-health risk assessment, visit www.kentuckyonehealth.org/heart-disease-risk-factors.

UK medical school at Bowling Green, similar to deal with Ashland and Morehead hospitals, is aimed at addressing doctor shortage

The Medical Center and Western Kentucky University
already cooperate on other medical-education programs.

Officials and civic leaders in Southern Kentucky have high hopes for a medical school partnership between the University of Kentucky, Western Kentucky University and The Medical Center at Bowling Green, Deborah Highland reports for the Bowling Green Daily News. UK has a similar partnership with King's Daughters Medical Center in Ashland, St. Claire Regional Medical Center in Morehead, and Morehead State University, also aimed at the state's physician shortage.

The Bowling Green deal "is poised to help alleviate a physician shortage in the region, allow WKU faculty access to medical research opportunities, demonstrate a community commitment to smart growth and help keep the area's best and brightest in Warren County," Highland writes. "Medical school students will attend classes here in Bowling Green in a building on the campus of The Medical Center. The medical degree will be conferred by UK, and a certain number of slots in the program here will be available first to WKU students," starting with 30 in 2018.

Dr. Don Brown, The Medical Center's director of medical education, told Highland, "It's not every day that you're able to get a medical school in your community and this is a big accomplishment. . . . The closest medical school to us is Louisville or Vanderbilt" University, in Nashville. "We lose a lot of pre-med students to medical schools and they go away. We know if a Kentuckian trains in Kentucky, he or she is likely to stay in Kentucky."

Connie M. Smith, president and CEO of Med Center Health, told Highland in an email that the school will be in "new construction" on The Medical Center campus, not in the Health Sciences Complex at WKU, which houses the university's nursing and physical-therapy programs.

"Kentucky, like many other rural states across the nation, faces a shortage of physicians who are desperately needed to care for our aging population," Smith said. "This problem will only increase in scope if creative solutions are not identified."

Smith added, "We are already witnessing a level of excitement and intrigue throughout our medical community in regards to this project. Most physicians feel a responsibility for training the next generation, and they take this responsibility very seriously. We believe the medical school will bring about an unprecedented level of commitment to delivering the best in evidence-based care to patients throughout our region."

WKU Provost David Lee said, "This is a part of the state that needs more doctors, and it needs more medical professionals of all kinds,"I think this is only going to enhance the health care that is available to citizens of south-central and Western Kentucky."

Ky. again No.1 in adult smoking: 25.9 percent, just ahead of W.Va.

By Melissa Patrick
Kentucky Health News

Once again, Kentucky ranks first for its adult smoking rates, barely inching ahead of West Virginia to take back the first place spot, according to the federal Centers for Disease Control and Prevention.

Kentucky's adult smoking rate in 2015, the latest period available, is 25.9 percent; West Virginia's is 25.7 percent. That means that more than one-fourth of the adults in both of these states smoke. Arkansas closely follows at 24.9 percent.

States with the lowest smoking rates are Utah at 9.1 percent and California at 11.7 percent.

"Tobacco use is the leading cause of preventable disease and death in the U.S., accounting for more than 480,000 deaths every year, or one of every five deaths," says the CDC.

Nationwide, smoking rates have declined almost 28 percent since 2005, to 15.1 percent in 2015 from 20.9 percent in 2005, says the CDC report based on the 2015 National Health Interview Survey. Kentucky's smoking rates declined 10 percent in the same time frame, from 28.7 percent to 25.9 percent respectively, according to the Behavioral Risk Factor Surveillance System, a constant national poll conducted by the CDC.

The report also notes that smoking is more prevalent among men, Native Americans, the poor, the less educated, Midwesterners and Southerners, people who on are Medicaid or are uninsured, and those who have a disability, are gay or bisexual, or have mental-health issues.

The CDC says we know how to reduce smoking: "Proven population-based interventions, including tobacco price increases, comprehensive smoke-free laws, anti-tobacco mass media campaigns and barrier-free access to tobacco cessation counseling and medications, are critical to reducing cigarette smoking and smoking related disease and death among U.S. adults; particularly among subpopulations with the highest smoking prevalence," said the report.

Kentucky has room for improvement in all of these areas.

Kentucky ranks in the bottom 10 states (43rd) for its cigarette tax, at 60 cents per pack, and spends only 4.4 percent of what the CDC recommends for smoking cessation efforts ($2.5 million a year). The state's high smoking rate also comes with a hefty price tag, as the Campaign for Tobacco-Free Kids estimates Kentucky smoking-related health costs at $1.92 billion a year. The group ranks Kentucky 37th in protecting children from tobacco, and says 17 percent of its high-school students smoke.

And though Kentucky has tried to pass one in the past, Kentucky does not have a comprehensive statewide smoke-free law and isn't likely to get one any time soon because Republican Gov. Matt Bevin does not support such a law, saying this should be a local decision. State Health Commissioner Hiram Polk said in October that he's looking for away to get Bevin to alter his policy: "We've got to find some kind of landmark we can use there that would be acceptable to the governor and get through the legislature."

About one-third of Kentuckians are protected by local comprehensive smoke-free workplace laws, according to the Kentucky Center for Smoke-free Policy.

In contrast, Utah, which has the lowest smoking rate (9.1 percent), does have a comprehensive statewide smoke-free law, has a cigarette tax of $1.70 per pack and spends $7.1 million on tobacco cessation initiatives, which is almost 37 percent of the CDC's recommended spending. And Utah spends less on health cost caused by smoking at $542 million.

Many Kentuckians on Obamacare have higher deductibles, fewer options and fewer providers; signup deadline extended to Dec. 19

Kentuckians who are signing up for health insurance through the federal exchange are not only facing higher prices and fewer plan options, they are also finding fewer doctors and hospital choices on their plans, Boris Ladwig reports for Insider Louisville.

"While the rising cost of the plans will have a muted impact on most people — federal subsidies will offset much of the higher premiums — the shrinking networks could force people to change doctors, drive longer distances for care and could mean losing access to out-of-state specialists they’ve been seeing for decades," Ladwig reports.

Graphic via Insider Louisville

The problem is that Anthem Blue Cross Blue Shield, the only health insurance provider offering coverage on the exchange in every county for next year, has dropped some Preferred Provider Organization (PPO) plans and will only offer a Health Maintenance Organization (HMO) plan in 74 counties.

PPO plans typically have higher costs and higher deductibles, but provide access to a larger network of doctors and hospitals than HMO plans do. They also allow consumers to see out-of-network providers and require the consumer to pay a higher share of the costs. HMO plans are cheaper, but offer fewer doctors to choose from and consumers can't see an out-of-network provider, unless they pay 100 percent of the cost for that visit or procedure.

Last year, Anthem offered PPO plans in every Kentucky county, but this year is only offering PPOs in 46 of them. "Of the company’s 75,000 individual customers in Kentucky this year, 80 percent are on PPO plans," Ladwig writes.

For example, Ladwig reports that in Louisville, Anthem's PPO plan this year allows consumers access to 15 hospital in the area, but next year's HMO plans will decrease this choice to 12. And Lexington's hospital network falls from 19 this year to eight next.

While customers in Louisville will continue to have a large network of providers on Anthem, Lexington's customers are complaining because Lexington Clinic is not in Anthem's network, which is one of the main primary care and specialist providers in the area, Ladwig reports. Lexington Clinic's website says it employees more than 200 providers, has a staff of 1,000 and claims about 18 percent of the Fayette County health care market.

Griffin Meredith, president of Commonwealth Insurance Partners, a Louisville-based health insurance broker. told Ladwig that his Lexington clients have not reacted well to this news. “They’re pretty angry,” he said.

Lisa Gillespie of WFPL reported in October that "rural areas will be most affected by the reduced choices," offering an example from Louisa, population 2,482, which will now have to drive 31 miles north to Ashland's Kings Daughters Medical Center to go to the hospital, instead of driving 2.4 miles to Three Rivers Medical Center, which is not in the Anthem HMO.

CareSource and Humana will only offer exchange plans in certain counties. United Healthcare, Baptist Health Plans and Aetna pulled out the Kentucky market, citing financial reasons.

Ladwig writes, "Anthem said that much like in years past, it is making changes to its products based on market dynamics and consumer preferences."

Mike Lorch, the insurer’s regional vice president, told Ladwig that the company has worked hard to expand the HMO networks and that if hospital systems meet their requirements, which includes reimbursement rates, they can become part of the network.

As an example, Lorch cited St. Elizabeth Healthcare in Northern Kentucky, which includes about 90 percent of the adult primary care providers in the region. It was not part of Anthem's HMO network last year, but signed on this year.. Bill Banks, vice president of the hospital, said they were able to become part of the network "after Anthem raised its reimbursement rates to a reasonable price," Ladwig writes.

The state Department of Insurance requires insurance company networks to provide all customers with access to a hospital within 30 minutes or 30 miles.

The deadline to sign up for coverage effective Jan. 1 has been extended until Monday, Dec. 19. The last day to sign up for coverage is Jan. 31, to have coverage in place no later than March 1, 2017. Those who do not sign up for health insurance will have to pay a penalty of $695 per uninsured adult.

Rep. Tom Burch, ousted as House Health and Welfare chair by Republican takeover, gives the gavel to Rep. Addia Wuchner

Rep. Tom Burch

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – After 30 years as chair of the House Health and Welfare Committee, Rep. Tom Burch of Louisville is out, due to Republicans' takeover of the House in last month's election. His successor is Rep. Addia Wuchner of Florence.

Burch presided over his last meeting Dec. 14, but not before he was honored with a formal citation, a standing ovation from a packed committee room and kind words from members of the Interim Joint Committee on Health and Welfare, which also has senators.

"He has led this committee very diligently, very thoughtfully," said Sen. Julie Raque Adams, R-Louisville, chair of the Senate Health and Welfare Committee. Addressing Burch, she said, "I can't express to you what I know so many in Kentucky feel toward you, because you committed yourself to bettering the lives of families and children and countless others."

Democratic Sen. Julian Carroll of Frankfort, governor in 1974-79, said, "I have known Tom Burch for all the years that he's been in Kentucky state government and I've not known any individual that is more committed to public service, and particularly to the health and welfare of Kentuckians than is Tom Burch."

Burch graciously thanked his committee members and said he had the "highest respect" for all of them, even though they occasionally disagreed, recognizing they were all there for one purpose: "to serve" their constituents.

"It's been a real honor to serve 30 years as chairman of this committee," Burch said, adding later, "We've passed a lot of good legislation out of here, a lot of good legislation that people in Kentucky are better off for."

Burch is the longest serving House member, at 43 years, and was recently elected to serve another two. He said he had served on the Health and Welfare Committee for about 38 years and been its chairman for three decades.

"It hurts to give up this committee, but I believe to the victor go the spoils and I've enjoyed that for the 43 years I've been here," he said.

Rep. Addia Wuchner

Burch welcomed Wuchner to his chair: "This committee has always had a chairman who had a heart. . . . And now, we have a new chairwoman, Addia Wuchner, who also has a heart and I think she will do a good job on this committee."

Wuchner said in a telephone interview after the meeting that she had called Burch that morning, and stressed that his last day as chairman was a day to honor his service.

"He has been very dedicated all across the gamut of health-care issues and especially those that impact the lives of children and some of our most vulnerable citizens," she said.

Wuchner has served in the House since 2005, and been on the Health and Welfare Committee the whole time. She is a registered nurse and a former hospital administrator. Her website says she has worked in health care for 26 years.

Asked if her medical background qualified her for the chair, Wuchner said she recognized the benefits, but said the most important strength that members of this committee have in common is a "passion for serving."

Wuchner said she did not have an agenda set for the short legislative session that begins Jan. 3. However, she said the committee would consider some "very good legislation" that hadn't been heard before because of partisan differences. That is expected to include anti-abortion bills, which Burch has largely refused to hear.

"My hope for the committee," Wuchner said, "is that we will take up the challenges that we are given and the scope and the body of what we have to do so that we will improve the health outcomes for the citizens of Kentucky."

Surgeon UK ousted has his say in Lexington TV report

A renowned surgeon barred from practicing or teaching at the University of Kentucky for abusive behavior said in a television interview this month that "I think you have to be somewhat of an S.O.B." to be a good surgeon.

Dr. Paul Kearney also repeated his allegation, made in his whistleblower lawsuit against UK, that he was forced out because he called for an independent audit of the Kentucky Medical Services Foundation, which handles billing for UK doctors and is used for many purposes by UK HealthCare.

UK spokesman Jay Blanton said the foundation is audited every year and called Kearney's request "a smoke screen . . . because he's got 20 years of abusive behavior that's caught up with him." Blanton said UK erred by not getting rid of Kearney sooner, reports Miranda Combs of Lexington's WKYT-TV. "After he asked for that audit, a patient and more staff came forward, questioning yet again Kearney's professionalism," Combs reports.

Combs said Blanton gave her a timeline of complaints and actions regarding Kearney dating back to 1992, and Kearney gave her his personnel file with evaluations back to 1988. "He moved up the professional ladder and landed as the head of trauma surgery at UK. But throughout the climb, there was a theme of behavior issues, sprinkled at the end of mostly rave reviews," Combs reports.

Kearney explained, "If you're in a trauma situation where there's life and death, somebody's dying right in front of you and you're directing a team, it's like being in combat. It's like people are shooting at you. . . . I think you have to be somewhat of an S.O.B. to be a good [surgeon]."

Combs' video report shows his 2012 evaluation, which called him "indispensable" but said "He has had some issues with staff with allegations of unprofessional behavior." The evaluation form says Kearney refused to sign it.

In fall 2015, UK banned Kearney from surgery and teaching but kept him on the payroll. "Two independent panels of doctors, his colleagues, sixteen doctors altogether, reached a unanimous conclusion," Blanton told Combs. "You can't have a work environment where people are afraid, where they feel like they are going to be abused. . . . Being good with a scalpel is not an excuse to treat people abusively."

The WKYT video shows Kearney removing a gall bladder at "Surgery on Sunday," a nonprofit, including some pointed banter among Kearney and the operating-room staff. He says "My assistant's fat head is in the way" of the camera, and a staffer asks him, "Do we have to do everything for you?" He replies, "Yes, dear. ... I'm the doctor." Introducing that segment, Combs tells her audience, "If Dr. Paul Kearney has a filter, it's hard to find."

KentuckyOne Health will no longer manage U of L hospital; executive that helped do the deal gets $1.5 million to go away

The University of Louisville and KentuckyOne Health are ending the joint operating agreement under which KentuckyOne has managed the University Hospital and the James Graham Brown Cancer Center.

"The decision ended a 3-year-old arrangement that was created to stabilize the faltering teaching hospital's finances and give KentuckyOne, a system made up of the former Jewish Hospital & St. Mary's HealthCare and St. Joseph Health System, a top-notch hospital," reports Joseph Gerth of The Courier-Journal. "The plan was for KentuckyOne to sink more than $1.4 billion into the hospital over 20 years But KentuckyOne, beset by financial troubles of its own, faltered in operating the hospital. It laid off several top executives in September, and in 2014 laid off 500 employees statewide while eliminating another 200 unfilled positions."

"Following a state investigation this summer showing that staffing shortages at UofL Hospital were compromising patient safety and care, KentuckyOne and UofL traded barbs in the press in October, as the university demanded more than $46 million in back payments from KentuckyOne Health," notes Joe Sonka of Insider Louisville. "The company countered with a lengthy response questioning UofL’s commitment to their joint operating agreement and the university’s transparency regarding how much of KentuckyOne’s $524 million in financial contributions have been invested."

Dr. Gregory Postel, U of L's interim executive vice president of health affairs, said the university and KentuckyOne would redefine their "academic affiliation agreement" to clarify KentuckyOne's role and faculty involvement at Jewish Hospital and the Frazier Rehabilitation Center. "The goal here is not to end the relationship, but to change it," Postel said.

Gerth reports, "He said what is happening is not a 'divorce' but that the management arrangement is being unwound."

David Dunn

Also on Tuesday, U of L health executive David Dunn, "whom the FBI investigated for alleged misuse of funds, will receive $1.15 million from the institution to relinquish his tenured position," Insider Louisville reports. Dunn helped design the deal with KentuckyOne, "according to Dr. Peter Hasselbacher, emeritus professor of medicine at UofL and president of the Kentucky Health Policy Institute," which first reported Dunn's departure.

"Dunn had been on paid leave for more than a year, since The Courier-Journal reported that the FBI was looking into allegations that he and two others had misspent federal grant money," Gerth reports. "The school did not negotiate a 'clawback' provision that would allow U of L to take back the money in the event that Dunn is found to have violated the law during his tenure there." Dunn made $809,000 a year, reports Kate Howard of the Kentucky Center for Investigative Reporting.