Saturday, March 31, 2018

Ky. legislators mull cigarette tax hike of 40 cents or more as way to close deal on budget, pensions; top Philip Morris lobbyist visits

Kentucky Health News

FRANKFORT, Ky. – As legislators scrambled to meet a deadline to pass a budget they can protect from the governor's line-item vetoes, they revived the idea of a higher cigarette tax -- but perhaps less than the 50 cents-a-pack increase passed by the House with its version of the budget.

That brought the top state-government lobbyist for the nation's largest tobacco company to Frankfort, and renewed pleas by advocates of a $1 increase that only such a large hike would make a real difference in Kentucky's smoking rate, second in the nation. They did that in response to talk of a 40-cent boost, which would make the tax $1 a pack, still well below the national average of $1.72.

The Coalition for a Smoke-Free Tomorrow argued afresh that unless the price goes up by at least $1, tobacco companies can keep smokers hooked by giving discounts to retailers and coupons to consumers, then gradually raising prices. The coalition said a $1 boost could be "the most significant and proven health-improvement measure the General Assembly could enact in their lifetimes."

Altria VP John Rainey
(Va. Public Access Project photo)
Top legislative leaders met separately Wednesday with John Rainey, director of state-government relations for Altria Group, the parent company of Philip Morris USA, U.S. Smokeless Tobacco Co. and other tobacco firms, Tom Loftus of the Louisville Courier Journal revealed.

The accounts by Senate President Robert Stivers and acting House Speaker David Osborne indicated that Altria can live with a 40- or 50-cent increase, but wants to make sure that it is limited to cigarettes, as the House bill did. The last hike, in 2009, applied to all tobacco products.

"They're interested in different components of the tax code, including what might happen with the cigarette tax, e-cigarettes, smokeless [and] products that haven't even been marketed," Stivers told Loftus. Altria has invested heavily in electronic cigarettes and is planning to introduce a "heat not burn" nicotine-delivery device.

House Majority Leader Jonathan Shell, who also met with Rainey, said "Tobacco taxes are just part of the conversation we're having."

Osborne told Loftus that an Altria lobbyist "was here to talk about a facility they own in Western Kentucky and just wanted to give his opinions on things and a perspective on how that impacts them," Osborne said. Altria's U.S. Smokeless plant in Hopkinsville uses the area's dark-fired tobacco.

Loftus noted that Altria spent $156,650 lobbying the legislature in the first two months of the session, "far more" than any other lobby, "but the second-largest spender on lobbying for the first two months of the session was a group on the other side of the tobacco-tax debate – the Foundation for a Healthy Kentucky, which reported spending $107,336 during the two months." The foundation staffs the smoke-free coalition.

The Senate initially rejected the House's tax plan, but now it and the budget appear to be the secodn step of "a grand bargain" that helped pass a surprise pension-reform bill Friday, Loftus reports: "The House accepts a pension bill, the Senate accepts some kind of tax increase — which would be styled as 'tax reform' by all who vote for it. Bottom line: The 2018-20 state budget would have enough revenue to fund education along the lines of the House plan while also addressing the needs of the state's beleaguered pension plans."

The House and Senate did not meet Friday. They are set to meet Monday, the last day they can pass a budget and still have time to override any line-item vetoes issued by Gov. Matt Bevin, who has 10 says (not counting Sundays) to act on bills once he gets them. The last day the General Assembly can meet this year is Saturday, April 14.

Bill to spur disposal of painkillers goes to Bevin; CVS says nine of its Kentucky pharmacies now have medication-disposal units

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill designed to inform Kentuckians about the importance of getting rid of their unused painkillers, and make it easier to do so properly, has been delivered to the governor's desk for his signature.

Sen. Alice Forgy Kerr
Senate Bill 6, sponsored by Alice Forgy Kerr, R-Lexington, would require pharmacists to inform customers about how to safely dispose of unused opioids and other controlled substances, and either provide or offer to sell them a product designed to neutralize drugs for disposal -- or provide on-site disposal.

Kerr told Kentucky Health News that shifting to a mindset of immediately getting rid of any unused pain medications will require a "cultural shift,"  much like when we had to learn to put our seat-belts on: "It took us a while."

But the shift is important, she said, because more than 70 percent of all opioid addictions result from misuse of prescription drugs.

"It's important that we educate our public about how important it is to clean out our medicine cabinets," she said. "It sounds so simplistic, but that is where the problem is starting. None of us realize that we kind of hoard our medications, even when we don't mean to." 

Kerr said many states are looking to see what kind of opioid disposal law Kentucky will pass. "This is a cultural change," she said. "We will be a national model on this."

The bill penalties has of $25 for a first offense, $100 for a second and $200 for each subsequent violation -- and a provision that Medicaid will not pay for the disposal aid. Changes made by a House committee allow pharmacies to give patients the required information orally, in writing or through signs, and clarify that the neutralizing agent can be made available for purchase or provided at no charge.

The bill passed the House 95-0 on March 22 with no discussion. The Senate agreed to the changes and passed the revised bill 36-1 on March 27, sending it to Gov. Matt Bevin.

A pilot program and some pharmacies are already working on this issue

On the same day SB 6 got final passage, Attorney General Andy Beshear announced that Kentucky is teaming up with CVS Health to launch a new medication-disposal program. It involves the placement of in-store disposal units in nine of the company's 24-hour pharmacies.

“One of the most dangerous places in a home is a medicine cabinet with unused opioids,” Beshear said in a news release. “Thanks to this initiative, many Kentuckians now have a convenient way to make their home safer and stop addiction before it starts by safely disposing of drugs at their local pharmacy.”

The units are located at the Harrodsburg Road and Todds Road stores in Lexington and in Elizabethtown, Frankfort, Georgetown, Louisville and Paducah. CVS said it will install units in 750 locations across the country.

In August, Beshear launched a pilot program designed to help residents in selected Kentucky locations to safely dispose of their prescription drugs in their homes.  This  program is working to distribute 50,000 "drug deactivation pouches," which has the potential to dispose of more than 2.2 million unused opioids, says a news release.

Edward C. Baig of USA Today reports that Walmart already offers a solution to dispose of unused prescriptions for free in all of its pharmacy locations; that Walgreens says it is the first drugstore chain to install safe medication disposal kiosks in its pharmacies and that last September, CVS said it would limit opioid prescriptions to seven-day supplies for new patients with acute conditions, in addition to the drug-disposal boxes at some locations.

Thursday, March 29, 2018

Bevin gets bill to ban most common type of 2nd-trimester abortion

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A  House bill to ban the most common kind of second-trimester abortion has finally passed and is headed to Gov. Matt Bevin's desk for his signature. But that may not be the end of it.

Rep. Addia Wuchner
House Bill 454, sponsored by Rep. Addia Wuchner, R-Florence, would prohibit an abortion procedure known as dilation and evacuation, or D&E, after roughly 11 weeks of pregnancy except in medical emergencies. Reuters reports that 16 percent of all abortions performed in the state use D&E.

The procedure involves dilating the cervix and removing the fetus using suction and surgical tools. If the bill becomes law, abortion providers found in violation of it would be guilty of a felony that carries a prison sentence. The women undergoing the procedure would not be prosecuted.

"This law here in the commonwealth is about the humane treatment of an unborn child, to protect an unborn child from dismemberment," Wuchner said while presenting the bill to the House.

Critics of the bill said it is unconstitutional and will likely face legal challenges.

A federal court struck down a ban on the procedure in Texas, and similar bans have been temporarily blocked in Alabama, Arkansas, Kansas, Louisiana, and Oklahoma while litigation proceeds. Mississippi and West Virginia have similar bans that haven't been challenged in court, because the bans aren't expected to have an impact on abortion services, according to the American Civil Liberties Union of Kentucky.

The bill passed the House March 12 by 71-11 vote and the Senate March 22 by 31-5. A Senate change was approved in the House March 27 by 75-13 to a room full of applause. The Senate change made the definition of "unborn child" to mean from fertilization until live birth.

Opponents of the bill also say that without legal access to D&E procedures, Kentucky women will be limited to undergoing more expensive abortions that would require a hospital stay, and that by law, no publicly owned healthcare facility can perform abortions, unless it's to save the life of the pregnant woman. In addition, they say that this is part of a larger anti-abortion strategy to ban the procedure altogether.

In 2016, the state's "informed consent" law was amended to require women seeking an abortion to have a face-to-face or live-chat consultation before the procedure.

 In 2017, when Republicans took full control of the General Assembly, it passed two abortion bills that were signed into law by Republican Gov. Matt Bevin, who was elected in 2015. One banned abortions after 20 weeks of pregnancy, unless the mother's life is in danger. The other required women to get an ultrasound before an abortion that included an audible heartbeat, and required the doctor to show and describe the image of the fetus to the patient before performing the abortion. This law was struck down in court, but the state has appealed.

The only remaining abortion clinic in Kentucky, EMW Women's Surgical Center in Louisville, is in a legal battle with the state over licensing issues.

Ky. Hospital Assn. joins Bevin suit against 16 Kentuckians who say changes he and feds are making to Medicaid are illegal

By Melissa Patrick
Kentucky Health News

The Kentucky Hospital Association has joined Gov. Matt Bevin's federal lawsuit against the 16 Kentuckians who filed a suit that claims his changes to the state's Medicaid program are illegal, stating in the court document that Kentucky hospitals will "suffer an injury" if the court doesn't rule them to be legal. That is based on Bevin's threat to end the 2014 expansion of Medicaid if a court blocks his changes.

In January, 16 Kentuckians filed a lawsuit claiming that federal officials violated federal law and perhaps the U.S. Constitution by approving changes to Kentucky's Medicaid program and declaring their intent to approve similar changes in other states. The suit did not name Bevin or his subordinates as defendants. The plaintiffs are represented by the National Health Law Program, a public-interest law firm; the Kentucky Equal Justice Center; and the Southern Poverty Law Center.

In February, Bevin sued the Kentuckians and the groups representing them and asked for the case to be decided in Kentucky, and "seeks to ensure that, as the architect and administrator of the waiver, the Commonwealth's voice is heard," his office said in a press release.

The state's new Medicaid plan, called Kentucky HEALTH for "Helping to Engage and Achieve Long Term Health," includes, among other things: work or training requirements, lock-out periods for failure to comply, and premiums and co-payments. The changes are set to be phased in, starting in July, and will largely impact Kentuckians who have gained Medicaid coverage through the expansion, which covers people with incomes up to 138 percent of the federal poverty level.

Bevin's threat to roll back the expansion program if Kentucky HEALTH is ruled unlawful seems to have pushed the hospital association to join his case.

KHA Senior Vice President Nancy Galvagni told the trade journal Inside Health Policy that hospitals plan to work with Medicaid recipients to help them meet the new requirements, Lisa Gillespie reports for WFPL.

“We’re supporting the waiver because we support expansion,” Galvagni told IHP. “We want to have the expansion in place, and if it’s contingent upon the waiver being in place, we want to make the waiver work.”

"If judges rule Bevin’s plan illegal and he makes good on his threat to completely do-away with Medicaid expansion, it would have a devastating impact on hospital finances," Gillespie writes. "Hospitals in Kentucky had $552 million in charity care costs in 2015 after the state expanded Medicaid. That compared with $2.4 billion in those costs from 2012."

KHA attorney Wesley Butler, of the Lexington-based law firm Barnett Benvenuti & Butler, told Gillespie that hospitals need to be included because health providers will be affected by the many changes.

“We recognize that the government has to make some difficult choices to manage a large program,” Butler said. “We would much rather us be proactive in managing those issues rather than allowing them to deteriorate as the program tends to do with a lack of innovation.”

The lawsuit says, “The absence of health care providers in this legal dispute would omit a principal party that actually provides the necessary health care services for a government health care program. . . . If the implementation of Kentucky HEALTH is found to violate the Constitution, its invalidation will have a state-wide impact on Kentucky health care providers.”

Gillespie points out that the Kentuckians' suit currently resides in the D.C. federal court under Judge James Boasberg, a judge appointed by former President Barack Obama. Most district judges in the Eastern District of Kentucky, where Bevin filed his suit, were appointed by Republican presidents.

Wednesday, March 28, 2018

County-by-county figures on Medicaid enrollment updated

Counties in bold are some that will be represented by
attendees at KHN's Friday health reporting workshop.
How many people in your county are beneficiaries of the federal-state Medicaid program? How many of them are on Medicaid, thanks to its 2014 expansion under the Patient Protection and Affordable Care Act, and thus most affected by changes coming in the program?

The figures are in this spreadsheet, downloadable from Kentucky Health News, which obtains the data from the Cabinet for Health and Family Services, under the state Open Records Act. The data are for January 2018; the previous spreadsheet was for June 2017.

Sunday, March 25, 2018

No-penalty bill to require bicycle helmets dies, as some senators counted as 'yes' votes fail to show up for final committee meeting

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – A no-penalty bill to require children under 12 to wear a helmet when bicycling has died for this legislative session, after falling one vote short in the Senate Transportation Committee March 14, and being passed over due to absences at the next meeting, on March 21.

"Adequate notice was given to members of both parties that this bill was going to be up, and some votes that I thought the sponsor could count on didn't show up," committee Chair Ernie Harris, a Republican from Prospect in Oldham County, said after the meeting. He said the bill is dead.

Democratic Sens. Gerald Neal of Louisville and Johnny Ray Turner of Prestonsburg, as well as Republican Albert Robinson of London, were absent.

Rep. Regina Huff
House Bill 52 would require children under 12 to wear a helmet when they ride a bicycle. Violation would result in a courtesy warning, not a fine.

"We had three votes that were nos, and the rest were yeses," sponsor Regina Huff told Kentucky Health News. "Somehow they all weren't in the meeting on the same day, and I don't know if that's by chance or by design quite frankly." The bill passed the House 77-5 on Feb. 2.

At the March 14 committee meeting, two senators that the Brain Injury Alliance of Kentucky expected to vote for the bill voted against it, and three who were expected to vote yes were absent, according to BIAK.

The lobbying group calls HB 52 "TJ's bill" for TJ Floyd of Oldham County, who suffered a traumatic brain injury (TBI) when he flipped over his handlebars while not wearing a helmet at age 7 in 2010. It says 384 American children die annually from bicycle crashes, and 450,000 more are treated in emergency rooms for bicycle-related injuries, with about 135,000 of those seen in the ER related to head injuries.

"It is a bill for safety, for children at play to be safer when they are riding their. bikes," said Huff, a Republican from Williamsburg in southeastern Kentucky. "Helmets are 84 to 89 percent effective against a TBI, and prevention is the only cure for a TBI." 

But Sen. Paul Hornback, R-Shelbyville, who changed his vote to a no, said it would be "an overreach by government." He told Kentucky Health News that after talking to other policymakers and several lawyers, he became concerned about the implications for owners of private property on which children might ride bicycles and non-relatives who might be caring for them when bicycling.

Sen. Ernie Harris
Kentucky Health News asked Harris why he wouldn't hold a special meeting of the committee in the Senate chamber, when all members would likely be available. He said he had already given the bill two chances, which he had never done for a bill before – then said that it didn't have the support advocates thought.

"People have come up to me to say, 'I really don't want to vote on it, but if I have to, I will,' so the votes are not there," Harris said. "I have no explanation for why some people didn't show up. . . . I did everything I could to get people that would vote for it."

Clearly disappointed, Huff said the advocates would try again next year, and she was pleased it had received a hearing in the Senate for the first time. Similar legislation has been considered in the House for several years; last year's HB 122 passed the House 90-6 but was not heard in the Senate.

State not keeping up with 'explosion' of babies with hepatitis C

The dangerous liver virus hepatitis C "has skyrocketed among Kentucky births amid the state’s raging drug epidemic, but attempts to prevent, track and control the infectious, curable disease have fallen short," Laura Ungar reports for the Louisville Courier Journal. That means many kids don’t get the care they need, risking cirrhosis and liver cancer in adulthood — or even early death."

One in 56 Kentucky births in 2014-16 were to mothers with a history of the disease, Ungar reports, citing state records she obtained: "Those births more than quadrupled between 2010 and 2016, from 260 to 1,057 a year. The latest national rate, from 2014, was one in 308."

Just how many Kentucky children develop the disease is unknown, "because state records show most don’t get the necessary testing when they grow out of their moms’ immunity as toddlers," Ungar writes. "Research suggests Kentucky fares much worse than other states because drug use among young women is so widespread."

A federal study showed hepatitis C rose 213 percent in four years among women of childbearing age in Kentucky, from 275 cases to 862 per 100,000 women, Ungar reports: "That's nearly 10 times the national rise of 22 percent, from 139 to 169 per 100,000 women."

Courier Journal charts
“We have seen a dramatic increase in the number of cases of children exposed to hep C – an explosion,” said Dr. Kristina Bryant, a pediatric infectious disease specialist affiliated with Norton Children's Hospital, told Ungar, who notes, "The true scope of the problem is even bigger; more than half of people with hep C don’t know they have it."

Ungar discovered another problem: Kentucky officials aren't tracking, preventing and testing for the disease as diligently as they could.

"Staffing shortages have kept cases from this year and last — and a backlog of previous cases involving children — from even being entered into computers," she reports. "Moms and kids have often gone untested. Hep C screening isn’t mandatory. While it’s recommended for moms at high risk, doctors don’t always ask about drug use and women don’t always admit to it. Plus, babies whose moms have hep C commonly don't get follow-up testing, especially when they’re raised by someone else."

Ungar adds, "Overall efforts to curb hep C have failed." She notes Kentucky had the nation’s highest rate of acute hep-C infections in 2010-14, and "The state and federal governments spend a fraction of what advocates consider necessary to fight the disease; groups are asking for $100 million more at the federal level."

Ungar's story, which took up more than two pages in the Courier Journal's print edition, includes several case studies of families affected by the disease. It was initially published online by USA Today, for which she also works.

Saturday, March 24, 2018

House bill to allow detention and treatment of revived overdose victims falls short in Senate panel and is likely dead for session

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- Despite considerable support for the concept, a bill to allow first responders to detain and hospitalize individuals who have been revived after an overdose is likely dead for this legislative session, due to concerns about liability and personal freedom.

Rep. Kim Moser
House Bill 428, sponsored by Kim Moser, R-Taylor Mill, would have applied only in Lexington, Louisville and Northern Kentucky because they have resources in place to immediately connect overdose victims with treatment.

Moser, who is also the director of the Northern Kentucky Office of Drug Control Policy, told the Senate Health and Welfare Committee that the bill was inspired by first responders who are often called to resuscitate the same person for opioid overdose multiple times, but can't get them to treatment.

Moser said the bill also has the support of citizens who are increasingly frustrated with the ever-increasing use of expensive Narcan to revive overdose victims at taxpayer expense, with no requirement for treatment. Currently, victims can refuse further treatment and simply walk away. She said the number of overdose deaths is "going down because we are saving people with Narcan, but we are not able to get them into treatment."

Moser and her guests at the March 8 House Health and Family Services Committee meeting said the average cost of Narcan is $110 per dose and the state spent $1.66 million in 2017 to administer 15,000 doses of Narcan, not including Louisville's Narcan expense -- or the cost of ambulance runs.

The House committee approved the bill without dissent and the House passed it 92-3, but it couldn't muster enough support in the Senate health committee. The chair, Sen. Julie Raque Adams, R-Louisville, passed up a vote after a long debate and said the bill would remain on the committee agenda.

Sen. Danny Carroll, R-Paducah, a former police officer, voiced concerns about the liability the bill would place on police officers and their departments because of the fine line between detention and arrest.

"I question the legality of doing this without actually having a criminal statute to detain them," Carroll said. "Don't get me wrong, I applaud you for the effort and I understand that we need to take stricter measures to control these situations. I don't want to put our officers at risk of civil suits."

Moser responded that the bill's "immediate detention form," which must be signed by a peace officer, covers this concern, making the bill "legal and constitutional." Christopher Nieves, special agent with the federal Bureau of Alcohol, Tobacco, Firearms and Explosives, cited a Supreme Court case to support Moser's claim, but Carroll and Sen. Reginald Thomas, D-Lexington, disagreed.

"Under criminal law jurisprudence, arrest is defined as the absence of freedom of movement," Thomas said, and suggested that the bill should have probably been placed in the Judiciary Committee. "I have no problem with the intent of this bill," he said. "But I just think that this bill, as presently written, is flawed and I can't vote for it."

Republican Sen. Ralph Alvarado, a Winchester physician, voiced concerns about infringing on individuals personal freedoms, adding that as a physician he can recommend treatment all he wants, but people don't have to follow his recommendations.

"It's not necessarily holding them against their will in the ER," said Moser. "As with any other patient, they can get up and leave. It does get them to the hospital. The immediate detention is creating a touch point."

Sen. Steve Meredith, R-Leitchfield, suggested that the program be called a pilot because otherwise it would create a dual standard of care that could create confusion. "I do appreciate what you are attempting to accomplish," he said.

Earlier, Nieves noted that HB 428 was modeled after an Indiana bill to address the same problem, and that he had found it to be effective. He said that simply giving Naloxone without connecting the individual to treatment was nothing more than a band-aid. "I think we are shortchanging ourselves if we don't get these people long-term treatment," he said.

Sen. Julian Carroll, D-Frankfort, also a lawyer, agreed with Moser and Nieves. "We need to do something," he said.

Steve Rath, assistant chief of Southgate Volunteer Fire Department in Campbell County, told the panel that the bill had wide support among firefighter organizations and that this bill would give them another tool in their toolbox to get people to treatment, and also create a record of repeat offenders.

Moser told Kentucky Health News  the bill is likely dead but she would continue to work on it.

Rep. Addia Wuchner, R-Florence, who chairs the House health committee and was standing nearby, said, "Nothing is buried until sine die," the final motion of any session.

Rural health clinics claim drug makers and distributors 'created and engineered' opioid epidemic, seek national class action

"Two rural Kentucky health clinics are trying to open a new front in the legal battle against drug companies that allegedly used improper tactics to fan an epidemic of addiction to powerful painkillers called opioids," Bill Estep reports for the Lexington Herald-Leader.

“These pharmaceutical companies aggressively advertised to and persuaded practitioners to prescribe highly addictive, dangerous opioids, and turned patients into drug addicts or dependents for their own corporate profit,” charges the complaint by Family Practice Clinic of Booneville Inc., and Family Health Care Clinic PSC of Richmond. It says the firms "created and engineered" the epidemic.

"Their lawsuit lists more than 20 defendant pharmaceutical manufacturers and distributors," Estep reports. "Some of the companies are subsidiaries of others in the complaint. Three attorneys with the Lexington firm of McBrayer, McGinnis, Leslie & Kirkland, along with a firm from Georgia, filed the lawsuit for the clinics."

Estep notes, "Lawsuits seeking damages from drug companies for conduct that allegedly worsened the drug crisis in Kentucky and the nation are not new. There are hundreds of such cases pending around the country." But this one is the first by rural health clinics, according to David J. Guarnieri, one of the Lexington attorneys.

The suit seeks unspecified damages and asks that it be made a class action on behalf of more than 4,100 rural health clinics, including 745 in Appalachian areas of Kentucky (which has 191), Alabama, Mississippi, North Carolina, Ohio and Tennessee. “They’re on the front lines dealing with the opioid crisis,” Guarnieri said.

"The lawsuit argues that drug makers used false and misleading claims to push their products, such as down-playing the risk of addiction; claiming that it is easy to manage opioid dependence and withdrawal; and denying risks from using higher doses of the drugs," Estep reports. "It also alleges the companies targeted vulnerable patient populations, including people served by rural health clinics in Appalachia. There is a high prevalence of “societal risk factors which contribute to an increased and widespread abuse of opioids” in the region, the lawsuit says, including lower income; lower educational attainment; depression; a higher portion of jobs prone to injuries; and poor health status."

The suit claims distributors of the drugs failed "to stop suspiciously large shipments of painkillers and by not reporting red flags about possible diversion of prescription pills to the government as required," Estep reports. It says addiction to opioids "drives up costs for rural health clinics, not just for providing treatment but for added needs such as regulatory compliance and security; lost employee productivity; and having to kick out patients for abusing or diverting prescribed drugs."

Friday, March 23, 2018

Ban of most common type of 2nd-trimester abortions nears passage; foes say it's part of larger strategy to ban abortion

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A House bill to ban the most common method of second-trimester abortion is near final passage after passing out of the Senate Judiciary Committee and the Senate on the same day, despite warnings that its passage would lead to a legal fight.

Committee Chair Whitney Westerfield, R-Hopkinsville, said concerns about being sued over a bill that protects an unborn child and the potential legal cost to taxpayers shouldn't be a consideration in voting for this bill. "It's worth challenging precedent," he said.

Rep. Addia Wuchner
House Bill 454, sponsored by Rep. Addia Wuchner, R-Florence, would prohibit an abortion procedure known as dilation and evacuation, or D&E, after roughly 11 weeks of pregnancy except in medical emergencies. The procedure involves dilating the cervix and removing the fetus using suction and surgical tools.

If the bill becomes law, abortion providers found in violation of it would be guilty of a felony that carries a prison sentence. The women undergoing the procedure would not be prosecuted.

A federal court has struck down a ban on the procedure in Texas, and similar bans have been temporarily blocked in Alabama, Arkansas, Kansas, Louisiana, and Oklahoma while litigation proceeds. Mississippi and West Virginia have similar bans that haven't been challenged in court, because the bans aren't expected to have an impact on abortion services, according to the American Civil Liberties Union of Kentucky.

Sen. Wil Schroder, R-Wilder, told both the committee and the full Senate that no federal judge from the Sixth Circuit of the U.S. Court of Appeals, which covers Kentucky, has ever ruled on such a law.

Wuchner said at the March 22 committee meeting that the bill did not prohibit all abortion methods after the 11-week mark in Kentucky because Kentucky women would still be able to get a second-trimester abortion through the induction of labor or a procedure called dilation and curettage, or D&C, which involves dilating the cervix and removing the contents of the uterus by scraping and scooping.

In presenting the bill on the floor, Sen. Stephen Meredith, R-Leitchfield, said, “Abortions by dismemberment, crushing or suction are brutal procedures which are and should be considered repulsive, barbaric and inhumane by any society standards. “This bill upholds basic human dignity.”

Opponents of the bill said that without access to legal D&E procedures, Kentucky women will be limited to undergoing more expensive abortions that takes longer and involve a hospital stay.

Marcie Crim, executive director at Kentucky Health Justice Network, told the committee that Kentucky Revised Statute 311.800 will make getting an abortion after 11 weeks near impossible because it says that no publicly owned hospital or publicly owned healthcare facility can perform abortions, except to save the life of the pregnant woman -- and most of Kentucky's hospitals are either publicly owned or owned by a religious organization.

The bill passed the Senate 31-5, with Democrats Julian Carroll of Frankfort, Reginald Thomas of Lexington and Perry Clark, Denise Harper Angel and Morgan McGarvey of Louisville voting against it. Sens. Gerald Neal of Louisville and Robin Webb of Grayson did not vote.

The bill returned to the House for consideration of a change made in the Senate to add a definition for "unborn child." The bill passed the House March 12 on a 71-11 vote.

Tamarra Wieder, director of external affairs for Planned Parenthood Advocates of Indiana and Kentucky, told the committee that experts from the American Congress of Obstetricians and Gynecologists oppose such laws.

"This bill is part of a larger anti-abortion strategy to ban abortion law by law, method by method," she said. "House bill 454, which uses inflammatory, non-medical language to ban abortion, is further proof of this bill's intent."

In 2016, the state's "informed consent" law was amended to require women seeking an abortion to have a face-to-face or live-chat consultation before the procedure.

In 2017, when Republicans took full control of the General Assembly, it passed two abortion bills that were signed into law by Republican Gov. Matt Bevin, who was elected in 2015. One banned abortions after 20 weeks of pregnancy, unless the mother's life is in danger. The other required women to get an ultrasound before an abortion that included an audible heartbeat, and required the doctor to show and describe the image of the fetus to the patient before performing the abortion. This law was struck down in court, but the state has appealed.

The only remaining abortion clinic in Kentucky, EMW Women's Surgical Center in Louisville, is in a legal battle with the state over licensing issues.

Senate bill to create tele-heath payment model, with anti-abortion measure attached, advances to full House

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A Senate tele-health bill aimed at increasing access to care and saving the state money is awaiting a vote in the House, amid an objection from the state's largest health insurer and opposition to an amendment that would keep tele-health form being used in abortions.

Sen. Ralph Alvarado
Senate Bill 112, sponsored by Republican Sen. Ralph Alvarado, passed the Senate without dissent and has been placed in the regular orders of the day in the House. It includes a Senate amendment to prohibit tele-health from being used for abortions.

Alvarado, a Winchester physician, told the House committee that telemedicine has been proven to save money through such measures as "video conference follow-ups and remote patient monitoring that decrease hospitalizations and increase the quality of care."

He added that it allows physicians the ability to remotely monitor chronic diseases more efficiently, increases access to specialty care, increases access to mental-health care, decreases use of emergency rooms, and increases provider access to those with transportation issues.

Alvarado cited a study in the journal Health Affairs which he said found savings of 7.7 percent to 13.3 percent per patient, per quarter, for chronically ill Medicare recipients. In addition, he said the state-employee tele-health program had saved the state $2.5 million.

The bill would require the Cabinet for Health and Family Services to develop telemedicine policies, including a reimbursement model, with similar expectations for the public insurance market. It also requires health-care providers to be licensed in Kentucky in order to receive reimbursements, though they would be able to live anywhere in the world.

Committee Chair Addia Wuchner realized after the panel approved the bill without dissent that there were lobbying interests that wanted to speak against the bill, and she gave them a chance to speak.

Lawrence Ford of Anthem Blue Cross and Blue Shield, said that the insurance firm supports tele-health and its expansion, but has concerns about the bill's requirement that providers be paid the same amount for a tele-health visit as an in-patient visit, unless a lesser rate had been negotiated. He said a tele-health visit through Anthem now costs $49, while an average in-person visit cost $83.

He added that while there was no fiscal note attached to the bill, "There was a statement that was prepared by the Department of Insurance that stated that this legislation could increase health care costs for insurance plans by as much as $7.7 million."

"We have issues and oppose any efforts by the General Assembly to venture into rate-setting services between two parties," Ford said. Later, Rep. Jim Gooch, R-Providence, filed a floor amendment to remove the equal-payment provision.

Tamarra Wieder of Planned Parenthood Advocates of Indiana and Kentucky told the panel that while the organization supports tele-health, it opposes the restrictions that the amended bill placed on abortions, which she referred to as a "constitutionally protected medical service."

"Telehealth delivery of medication abortion has been demonstrated to be just as safe and effective as in-person protocols and to improve patient safety by enabling abortion earlier in the pregnancy when it is the safest," Wieder said.

Kate Miller of the American Civil Liberties Union - Kentucky said the amended bill would decrease rural Kentucky women's access to legal abortions, since the only abortion provider in Kentucky is in Louisville.

After the opponents spoke, Wuchner asked if any committee members wanted to change their vote. None did.

Thursday, March 22, 2018

Denied federal funding, study on the health effects of mountaintop-removal coal mining has been abandoned

"After Trump administration officials ordered a halt to a study on the health effects of mountaintop removal last fall, the study’s committee has been released, effectively terminating the project," Kate Mishkin reports for the Charleston Gazette-Mail.

"The National Academies of Sciences, Engineering and Medicine’s study would have looked at the health effects on residents who live near mountaintop removal coal-mining sites. It was put on hold when the Department of the Interior’s Office of Surface Mining announced that it was reviewing grants and agreements that would cost more than $100,000."

An Interior spokesperson did not answer any questions about why the study was terminated and whether it might be revived in the future. Riya Anandwala, a spokesperson for the National Academies, would not speculate on the reason for the study's termination, but told Mishkin it was "not unprecedented, but it's very rare."

Interactive map shows county data on Appalachian opioid overdoses, correlated with social and economic data

Lexington Herald-Leader map, drawn from Appalachian regional map by NORC, University of Chicago
A new data visualization tool offers in-depth, county-by-county information about the impact of the opioid epidemic in Appalachia and how it relates to factors such as unemployment, poverty, education and disability.

Screen grab of interactive map shows overdose rates with
highest in dark blue. (Click on the image to enlarge it.)

The Appalachian Overdose Mapping Tool, developed by a research organization and the Appalachian Regional Commission, "integrates overdose mortality rates for each Appalachian county with data on unemployment, poverty, and disability, as well as other socioeconomic variables. Users can compare county-level information with regional and national data and see changes in the data between 2006–2010 and 2011–2015. The mapping tool can also generate fact sheets to assist in community planning and response efforts," Wendy Wasserman of ARC reports in a press release.

"Residents across Appalachia are 55 percent more likely to die from a drug overdose than people in the rest of the country, but the disparity is even higher in some Eastern Kentucky counties.
In Leslie County, for instance, the overdose death rate is five times the national average," Bill Estep reports for the Lexington Herald-Leader. Leslie's rate is the highest in Kentucky; four West Virginia counties had higher rates.

Read more here:

Socioeconomic correlations shown by the interactive map include:
  • In Central Appalachia, counties with the highest rates of overdose are often the same counties with the highest rates of people on disability.
  • In Central Appalachia, the counties with the highest overdose rates are often the same counties with the lowest rates of educational attainment.
  • In Northern and Southern Appalachia, the highest overdose rates are in urban counties.
  • While Central Appalachia remains the most highly affected subregion of Appalachia, other subregions are experiencing increasing rates of overdose.
The map was developed by ARC and the University of Chicago's NORC, which was known as the National Opinion Research Center before its work expanded beyond opinion research.

Wednesday, March 21, 2018

Optometry bill delivered to the governor after Senate changes

By Melissa Patrick
Kentucky Health News

A bill to regulate online eye exams has been delivered to Gov. Matt Bevin after getting final passage from the state House.

On an 88-0 vote, the House agreed with the changes the Senate made to House Bill 191 to remove the original bill's requirement for "simultaneous" consultation between online, Kentucky-licensed eye-care providers and their patients, which critics said would have limited access to eye care and tele-health technologies going forward.

The Senate passed the bill 36-0 March 14 with an amendment that changed the word "simultaneous" to either "synchronous or asynchronous." The bill's sponsor, Rep. Jim Gooch, R-Providence, said the change represented a compromise between all sides of the issue.

The bill requires that a person to be 18 to use the online services, that a medical history be obtained, that the person must have had an in-person eye exam withing two years of the online exam, and that a patient is not allowed to get contacts for the first time during an online exam.

This is the first time regulations have been placed on the online eye-care industry in Kentucky. It was supported by optometrists, who have a strong lobbying and campaign-finance presence in the legislature, and opposed by ophthalmologists, who do not.

Sex-ed bill to require abstinence and monogamy be taught nears final passage; foes want comprehensive curriculum

By Melissa Patrick
Kentucky Health News

A Senate bill to require Kentucky schools to teach abstinence and monogamy in sex-education programs moved out of the House Education Committee March 20, with changes that removed all references to marriage. It was scheduled for a vote in the full House March 22, but was not called up for a vote.

Sen. Stephen Meredith
Senate Bill 71, sponsored by Sen. Stephen Meredith, R-Leitchfield, originally called for teaching that abstinence from sex "outside of marriage" is the expected standard for school-age children, but the House changed it to say that educators must teach that abstinence is the desirable goal for such children.

The amended bill also requires Kentucky's students to be taught that abstinence is the only certain way to avoid unintended pregnancy or getting a sexually transmitted disease. The original language referred to "out-of-wedlock" pregnancy.

It would also require students to be taught that the best way to avoid sexually transmitted diseases is to establish a "permanent, mutually faithful, monogamous relationship." That language replaced the original wording, "in the context of marriage."

The bill says "instruction shall include, but not be limited to" the content it specifies. Kentucky has no specified curriculum for sex education, though the state Department of Education is working on one.

Meredith spent a good deal of time talking about the push-back he has received from opponents of the bill, singling out Planned Parenthood, which he said opposes abstinence education because it has a "hidden agenda" to advance its "business model." He made similar comments on the Senate floor in January.

"They don't want our children just to be sexually aware. They want them to be sexually active, as early as possible," Meredith, a former hospital administrator, told the panel. "Planned Parenthood doesn't make money from abstinence and monogamy. They make their money from treating sexually transmitted disease, selling contraceptives and abortions."

Senate Democratic Leader Ray Jones of Pikeville called out Meredith in the chamber in January for similar comments, saying it was "preposterous" to suggest that any group wanted children to be harmed or abused. Jones voted for the bill.

Tamarra Wieder, director of external affairs at Planned Parenthood Advocates of Indiana and Kentucky, said after the committee meeting, "Planned Parenthood is a health-care provider. We want to make sure that everybody has access to information regarding their body so that they can make healthy choices, and that includes education that goes beyond abstinence only."

Other foes of the bill disputed Meredith's assertion that they don't want abstinence and monogamy to be taught as part of a comprehensive curriculum. "Abstinence is taught in every comprehensive sexuality education curriculum," Rev. Dawn Cooley of Louisville told the panel, and suggested that a comprehensive curriculum is what they should be voting on.

Sen. Denise Harper Angel
The Senate had an opportunity to do just that in a floor amendment filed by Sen. Denise Harper Angel, D-Louisville, in January, but the lawmakers  voted it down with a rousing "no" voice vote. The bill passed 32-5.

Harper Angel's amendment would have required Kentucky's health education standards to line up with national standards that call for "medically accurate, age-appropriate information on a broad set of topics, including and related to human development, relationships, decision making, as well as abstinence, contraception, and disease prevention."

Harper Angel told senators, "If the General Assembly is going to mandate certain standards, these standards need to be comprehensive health standards, not moral standards."

In committee, Rep. Attica Scott, D-Louisville, told Meredith that his bill was driven by a personal belief that he was trying to codify, and asked him why this was a political issue.

"There is a definite benefit to society," Meredith replied. "You see that many of the things that we are struggling with in our country is because those relationships aren't there. You look at the number of children who are raised by single parents today and we know immediately they are placed into a position of financial disadvantage that children who are born in a relationship with two people don't face. So I think this is a definite benefit to society and can't be discounted, shouldn't be discounted."

Scott responded, "As a single parent I disagree with you." That drew applause.

Retiring Rep. Gerald Watkins, D-Paducah, said in support of the bill that because more than half the people below the federal poverty level are single mothers, abstinence education must be part of the curriculum.

Opponents of the bill said its mandate-only approach, instead of mandating a comprehensive curriculum, sends a strong message to schools to teach abstinence-only curriculums -- which they say have been proven ineffective.

Kristen Mark, an associate professor in health education at the University of Kentucky, noted that Kentucky has the  seventh highest unintended-pregnancy rate in the U.S. and 58 percent of Kentucky high-school students report they have had sex by the 12th grade.

"Comprehensive sex education -- where abstinence is absolutely encouraged and is absolutely included, despite what might have been said in the last panel -- has worked in lowering unintended pregnancy, decreasing sexually transmitted infection rates and postponing sexual involvement among young people," Mark said. "These are goals we can all agree on. The data are very clear here."

Mark told the committee that it's important for Kentucky's children to grow up knowing how to navigate sexual experiences in a healthy way, and emphasizing abstinence doesn't do that.

"We really shouldn't be surprised by the MeToo movement," she said, referring to the campaign against sexual harassment. "We shouldn't be surprised that girls and women and boys and men don't know how to navigate consent, even in the best of sexual situations. We should not be surprised that victims of sexual assault are often very reluctant to ask for help. This is a result of shame-based, abstinence-only sex education, the kind that this bill supports."

Two supporters of the bill who spoke were from Lifehouse Maternity Home in Louisville. Its website says it is "designed to help women discover God's love for them and their children."

Michelle Bourke, donor-relations director for the home and a former teacher, said that with "our schools passing out birth control and condoms like candy," it's important for Kentucky's children to also be taught about abstinence, and stressed that the only way to prevent pregnancy and sexually transmitted diseases is through abstinence.

Monica Morgan, a resident of the home, told the panel that her decision to become "secondarily abstinent" allowed her to live a life of not worrying about sexually transmitted infections or becoming pregnant again. She stressed the importance of letting children know there are often unintended consequences of having sex, and that the only way to avoid them is to abstain.

The bill passed the committee 15-3 vote and now heads to the House floor for a vote. Scott and Reps. Mary Lou Marzian and Reginald Meeks, also of Louisville, voted no.

Monday, March 19, 2018

State leads nation in local syringe exchanges; still lacking in most counties judged vulnerable to disease outbreaks from IV drug use

By Al Cross
Kentucky Health News

Kentucky has long ranked high among the states in the number of counties. Now it leads the nation in the number of local syringe-exchange programs, according to the state Cabinet for Health and Family Services. But most of the counties deemed most vulnerable to outbreaks of HIV or hepatitis C due to intravenous drug use have not approved exchanges.

Forty-five of the state's 120 counties have approved syringe exchanges "in an effort to link people to treatment and improve overall public health," the cabinet says in a report on a recent syringe-exchange summit held by its Department for Public Health and the Kentucky Office of Drug Control Policy. The summit included people from counties without exchanges, to "help them, support them, encourage them in getting a syringe-exchange program going," said Dr. Ardis Hoven, the department's medical consultant.

"It's not just about the needle," Hoven said. "It's about folks getting tested for HIV and hepatitis C; it's about getting folks into care if they're positive for HIV or hepatitis C. It's also about getting those individuals with substance-abuse disorder into treatment . . . and we know that happens five times more frequently if they're engaged in a syringe-exchange program."

State Justice and Public Safety Secretary John Tilley said the exchanges are a better alternative than arrest and prosecution. "There's nothing more devastating than continuing to use a criminal-justice hammer to address a public-health nightmare," he said. "You exacerbate the problems the individual already has . . . When you entangle somebody in the criminal-justice system, you increase the likelihood that they'll not recover."

In 2016 the federal Centers for Disease Control and Prevention listed 220 U.S. counties most at risk to outbreaks of HIV or hepatitis C as a result of intravenous drug use. Of those counties, 54 are in Kentucky, and 26 of them have approved syringe exchanges. Approval is required by the county health board, fiscal court and legislative body of the city where the exchange is to be located. Here's a map from the cabinet:

Fiscal court in county with serious drug problem narrowly approves syringe exchange, then backs out

Clinton County (Wikipedia map)
Clinton County, which has a serious drug-abuse problem, took a big step toward becoming the fifth county in the 10-county Lake Cumberland Health District to approve a syringe exchange. Then it backed off.

The county Fiscal Court voted 4-3 in favor of the exchange March 15, with Judge-Executive Richard Armstrong casting the tie-breaking vote. "Armstrong noted that he was at first skeptical about the program himself, but the more he has learned about it, the more he was in favor of it," the Clinton County News reports. "He noted that if the program saved just one life it would be worth it. 'At least it’s an improvement,' he said."

Ricky Craig, one of the three magistrates who voted no, and one of Armstrong's five opponents in the May primary election, disagreed. “It’s like promoting drug use,” he said. He also noted that diabetics "are not eligible for free syringes in most cases," the News reports. "Craig also noted that the addict chooses to use the drug, while people who have illnesses like diabetes do not choose it."

Dr. William Powell of the county Board of Health "said the point of the exchange program was not to promote drug use but rather prevent disease," the News reports. Tracy Aaron of the Lake Cumberland District Health Department said drug users will exchange needles whether they are clean or dirty, and dirty needles are a health hazard.

The hazard is not just to users. Health board member Christy Guffey "noted that there had been syringes found at the park and other places, that are a danger to children and others, such as people who clean up roadways."

The health board has approved the exchange; the last hurdle was to be the Albany City Council, which next meets April 3. But on March 23, the fiscal court held a special meeting at which all the magistrates voted against the exchange and Armstrong did not vote, according to Alan Gibson, editor and publisher of the News.

Clinton County has one of the highest annual rates of drug-overdose deaths (9.62 per 10,000 people aged 15 to 64) in Kentucky, and the federal Centers for Disease Control and Prevention has ranked it 11th among U.S. counties most vulnerable to outbreaks of HIV or hepatitis C as a result of intravenous drug use.

Adjoining Russell County, with an overdose-death rate of 7.3, has adopted a syringe exchange. Others in the Lake Cumberland district that have done so are Adair, McCreary and Pulaski.

Kentucky at or near top in several measures of binge drinking

By Al Cross
Kentucky Health News

Binge drinking in Kentucky, which has been rising in recent years, is now among the heaviest in the nation, and tops in one measure. That's according to the latest study of the topic, by the federal Centers for Disease Control and Prevention.

The CDC defines binge drinking by consumption of alcoholic drinks in a two-hour period: five or more for men, and four or more for women, given their average weight difference. The study says binge drinking accounts more more than half of the 88,000 annual U.S. deaths attributed to alcohol.

The study was based on self-reporting through the CDC's continuous survey of adults, the Behavioral Risk Factor Surveillance System, and was based on data from 2015. In that year, 17 percent of U.S. adults reported at least one binge-drinking episode in the past year.

In Kentucky, the figure was 16.1 percent, with an error margin of plus or minus 1.5 percentage points.

While the percentage of binge drinkers in Kentucky is about the same or slightly smaller than the rest of the nation, Kentucky's binge drinkers have more binge-drinking episodes, and drink more during them, than those in other states.

Kentucky led the nation in the number of episodes reported by binge drinkers, at 72.8. Arkansas was second, at 69.6. The national average was 53.

Arkansas led in the total number of drinks people reported taking during binge-drinking episodes, but Kentucky was close behind. Arkansans reported 841, Mississippians reported 831, and Kentuckians were third, with 652. Next came Hawaiians at 611. The national average was 467.

The study also calculated the number of binge drinks per adult in each state. On that measure,
Kentucky was eighth, at 94 drinks. The highest was North Dakota, at 128.9 drinks. Alaska had 112.9, Arkansas 111.5, Hawaii 107.4, Wisconsin 105.3, Ohio 102.4 and Michigan 100.5.

Nationally, binge drinking is more common among people 18 to 34, but half of the total binge drinks were consumed by adults over 35. "Total binge drinks per binge drinker were substantially higher among those with lower educational levels and household incomes," the study says. It adds later, "More than half the alcohol sold in the United States is consumed while binge drinking."

The first county-level study of alcohol use, released by the University of Wisconsin three years ago, said Kentucky had the largest increase in drinking, heavy drinking and binge drinking from 2005 to 2012.

Sunday, March 18, 2018

Original sponsor of $1 cigarette-tax increase says it's not salable right now but hopes House-Senate negotiation keeps 50-cent hike

By Al Cross
Kentucky Health News

FRANKFORT, Ky. -- The state Senate's version of the budget will not include the House's 50-cent-a-pack cigarette-tax increase and 25-cent-per-dose tax on opioid prescriptions, and the original sponsor of a $1-a-pack hike says it is dead for the legislative session.

Stephen Meredith
"I don't think the dollar's sellable right now," Republican Sen. Stephen Meredith of Leitchfield said in an interview Friday. "I think the 50-cent is." He said that would be especially true as part of a comprehensive tax-reform package, more likely in a special session than the current one.

Senate President Pro Tem Robert Stivers, in announcing that the Senate wouldn't adopt the House taxes, suggested that a cigarette tax could be part of a broad tax-reform package. Republicans want to reduce income taxes, arguing that would attract more employers to the state, and a cigarette-tax hike could make up for the initial decline in income-tax revenue.

Referring to the revenues from tax increases in the House budget, Stivers said, "We are not recognizing any of those at this time" in writing the budget. "I can understand the health-care policy argument on that, and that same health-care policy argument is what makes it a tenuous type of predicate to revenues to build a budget on, because you are going to have a shrinking base, and I don't believe that in and of itself, as a stand-along, one-off tax is something that we should do."

Stivers spoke in the context of the opioid tax, which would be the first such tax in the nation, but the shrinking-base argument is also made against the cigarette tax, and the Lexington Herald-Leader reported that Stivers made that argument against it.

Advocates of increasing the current 60-cent tax to $1.60 argue that it would make some smokers quit, reducing the physical and economic toll that smoking takes on Kentucky. They say a $1 hike is needed because tobacco companies can counter a smaller increase with coupons and discounts, then gradually increase prices, to keep smokers hooked.

Senate health panel OKs 4 opioid bills; 3 quickly pass Senate

By Melissa Patrick
Kentucky Health News

Four of the seven bills that passed out of the March 14 Senate Health and Welfare Committee meeting dealt with opioids, and three of them have already passed out of the Senate.

A bill for safe disposal of unused opioids passed quickly out of the committee by a 9-1 vote and passed the full Senate later the same day on a vote of 34-2.  It now goes to the House.

Senate Bill 6 had been pulled off the floor and sent back to committee March 13, prompting sponsor Alice Forgy Kerr, R-Lexington, to say it was delayed in retaliation for her refusal to vote for the controversial public-pension bill. Senate leaders told Deborah Yetter of the Louisville Courier Journal that the bill needed a "technical revision."

The bill would require pharmacists to inform customers about how to safely dispose of unused opioids and other controlled substances, and offer to sell them a product designed to neutralize drugs for disposal. The committee added fines of $25 for a first offense, $100 for a second violation and $200 for each subsequent violation and a provision that Medicaid would not pay for the disposal aid.

Sen. Stephen Meredith, R-Leitchfield, cast the only no vote in committee. He said he supported the idea but had too many concerns about who would bear that cost. He also voted no on the Senate floor, along with Sen. Wil Schroder, R-Wilder.

Explaining his yes vote, Sen. Reginald Thomas, D-Lexington, said, "This is something that we need to move on. Something that we should not play politics with because the people who are affected don't care about Republicans and Democrats." Thomas is running for Congress.

Rep. Addia Wuchner, chair of the House Health and Family Services Committee, saw two of her opioid bills pass out of the Senate committee, and one of them is awaiting posting for House concurrence in a Senate amendment.

House Bill 148 would shift ownership of controlled substances from a deceased hospice patient to the hospice program for disposal. Such drugs now go to estates.

The bill would require hospice and other palliative-care agencies to have written policies and procedures for getting rid of certain painkillers upon the death of the patient. The policy would be reviewed with patients and their families, who would then be asked to agree to the policy in writing. The disposal of the drugs would be completed by the agency or the person pronouncing death and would be witnessed by an adult, who would sign a statement to the fact.

Families who do not agree would be reported to the local health department or local law enforcement.

Wuchner, R-Florence, told the committee that the bill is not meant to threaten families at a time of loss, but to stress the importance of the need to destroy the drugs. It went to the Senate floor without dissent.

House Bill 124 unanimously passed the health committee and the full Senate. It calls for a comprehensive review of all state programs for substance-use disorders, and would require the state to only pay for and license ones that follow nationally recognized, evidence-based protocols.

The Senate added an amendment to allow the Department of Corrections to purchase long-acting, medication-assisted treatment products for substance-use disorders that are resistant to diversion, including unspecified new ones not yet available.

Senate Bill 250 also unanimously passed out of the health committee and the full Senate and will now move to the House. It would require all pregnant women to be tested for hepatitis C, with the results added to the child’s records. It also recommends that the child be tested at 24 months if the mother tests positive. Hepatitis C can be transmitted from mother to baby during childbirth.

Riggs Lewis, system vice president of heath policy at Norton Healthcare, stressed the importance of screening every pregnant woman in order to be able to treat both the mother and baby. He noted that most new cases of hepatitis C are a result of illegal intravenous drug use, so cases are expected to increase. "This is going to be a shadow that follows the opioid epidemic," he said.

Dr. William P. 'Buddy' McElwain, health commissioner for Govs. Louie Nunn, Wendell Ford and Julian Carroll, dies at 84

Dr. W.P. McElwain in 2012
Dr. William P. "Buddy" McElwain, who was Kentucky's health commissioner under three governors in the 1970s, died Tuesday, March 13. He was 84.

McElwain was a graduate of Daviess County High School, Murray State University, the University of Louisville School of Medicine and Johns Hopkins University. After an internship and two-year residency, he served eight years in the U.S. Public Health Service, working at Indian reservations and the Oklahoma health department.

He was associate director of the Fayette County Health Department in 1970 when Gov. Louie B. Nunn, a Republican, named him state health commissioner. He kept the job under Gov. Wendell Ford and returned to it under Gov. Julian Carroll, another Democrat, until 1978, when he returned to medical practice and later worked at the University of Kentucky. He was executive vice president for medical affairs for the Kentucky Health Care Access Foundation, which Democratic Gov. Brereton Jones and the legislature created to provide health care for people who were below the poverty line but did not qualify for Medicaid.

From 1994 to 2012, he practiced at Rockcastle Regional Hospital and Respiratory Care Center in Mount Vernon. After retirement, he remained in the area.

McElwain is survived by a brother, Bob McElwain; sons Paul, David and Brandon McElwain, daughters Nancy Curtis and Ruth Childers, 10 grandchildren and three great-grandchildren. The funeral will be private. Memorial donations may be made to The Miracle Fund, Rockcastle Regional Hospital, 145 Newcomb Avenue, Mt. Vernon KY 40456. For his full obituary, click here.

Saturday, March 17, 2018

No-penalty bill to require kids under 12 to wear bicycle helmets falls 1 vote short in panel; advocates say it will be called up again

By Melissa Patrick
Kentucky Health News

A House bill to require children under 12 to wear bicycle helmets came up one vote short in the Senate Transportation Committee March 14, but advocates say the panel will take up the bill again Wednesday, March 21.

Mary Hass, advocacy director of the Brain Injury Alliance for Kentucky, told Kentucky Health News that two senators who were expected to vote for the bill voted against it, but it would still pass with votes of those who were absent.

House Bill 52, sponsored by Rep. Regina Huff, R-Williamsburg, would require children under 12 to wear a helmet when they ride a bicycle. Violation would result in a courtesy warning, not a fine.

Heather Floyd and her son TJ spoke at the March 14 Senate
Transportation Committee meeting in support of "TJ's bill"
to require children up to age 12 to wear a bicycle helmet.
HB 52 is called "TJ's bill" for TJ Floyd of Oldham County, who sustained a traumatic brain injury in 2010 when he flipped over his handlebars when he was 7 while not wearing a helmet. It passed the House 77-5 on Feb. 2.

"This bill just makes helmets part of bicycle safety," Hass told advocates at a rally after the committee meeting. "There are no fines. It is not meant to be punitive in any way to parents. But BIAK's membership is telling us it gives parents another tool in their toolbox to keep their children safe."

The bill needed seven votes to clear the committee, but only got six. After some off-microphone discussion about what to do next, committee chair Ernie Harris of Oldham County told members that he might call it up again. BIAK said in an email alert the next day that Harris would have the committee hear the bill again Wednesday, March 21 at 9 a.m. in Room 154 of the Capitol Annex. Kentucky Health News has not confirmed that with Harris.

Haas said advocates went into the March 14 meeting thinking they had enough votes, but one supporter, Sen. Jared Carpenter of Berea, was caught in a traffic jam, and another, President Pro Tem Jimmy Higdon of Lebanon, left before the vote was taken. Democratic Sen. Johnny Ray Turner of Prestonburg was also absent.

The "no" votes came from Republican Sens. Joe Bowen of Owensboro, C.B. Embry of Morgantown and Paul Hornback of Shelbyville. A BIAK alert said the group expected Hornback to vote for the bill but he changed his mind before the meeting.

Haas and TJ's mother, Heather Floyd, said Embry had said he would vote for the bill. Embry disputed that, telling Kentucky Health News, "I didn't tell them I was voting for it. I said I would give it consideration." He said the bill probably has enough votes to get out of committee if all members attend.

Embry said he voted no because he didn't think the bill is necessary, especially because it has no penalties. He also voiced concerns about liability if a child was injured while not wearing a helmet on someone else's property or under the care of someone who was not a family member.

"I think they should wear a helmet," Embry said. "I think that parents should require them to wear a helmet. I think they should have enough sense to do that on their own, without the government demanding it."

Sen. Mike Wilson, R-Bowling Green, voiced similar liability concerns during the meeting, but voted for the bill.

At the meeting, Floyd urged the panel to pass the bill to prevent similar injuries to other children. She shared a long list of cognitive and physical struggles that plague TJ and others with brain injuries and that have stripped him of his ability to live an independent life. She said the bill is about bringing awareness to traumatic brain injuries, which affect more than 5 million Americans, and the importance of protecting children's brains.

BIAK says 384 American children die annually from bicycle crashes and 450,000 more are treated in emergency rooms for bicycle related injuries, with about 135,000 of those seen in the ER related to head injuries. Hass said after the rally that bicycle helmets are about 85 percent effective in preventing traumatic brain injuries when used properly.

Mary Hass of the Brain Injury Alliance
for Kentucky spoke at the March 14 rally.
Floyd told the committee, "The biggest and most important point is that this bill can save a child's life."

BIAK Executive Director Eddie Reynolds said after the rally that opposition to the bill often stems from concerns about personal freedoms.

Haas said motorcycle advocates have opposed the bill out of concerns it would lead to restoration of an old law requiring Kentucky adults to wear helmets while riding motorcycles. Current state law requires both operators and passengers on a motorcycle under the age of 21 to wear a helmet.

"There is no will in this legislature to want to put helmets on people who ride motorcycles. We feel that is their choice," Haas said. "This bill is only about protecting children and doing what our membership has asked us to do."

Similar bicycle helmet legislation has been considered in the House for several years. Last year, HB 122 passed the House 90-6 but was not heard in the Senate.