State health official says Ky. is considering cutting nearly 500,000 people off of Medicaid because of a $300 million program shortfall

Health officials said the state is considering eliminating Medicaid coverage to almost 500,000 Kentuckians because the program is facing a nearly $300 million shortfall.

During a review of the 2018 fiscal budget and the outlook for 2019, Health Secretary Adam Meier told members of the legislature's Budget Review Subcommittee for Human Resources on Aug. 30 that Kentucky will be $296 million short by 2020, Adam Beam reports for The Associated Press. He added that dental, vision and pharmacy benefits are also on the table.

"That's certainly not anything we would want to do," Meier said, but "We also have a constitutional obligation to come in under budget. Unlike the federal government, we can't just print more money. We can't run a deficit."

Kentuckians at risk of losing coverage are the ones who gained it through the state's 2014 expansion of Medicaid, under the 2010 Patient Protection and Affordable Care Act, to those who earn up to 138 percent of the federal poverty level ( about $16,000 for a single person).

Medicaid is a federal-state funded program that covers about 1.4 million people in Kentucky, or about one-third of the state's population. The program costs about $11 billion a year, with most of it paid by the federal government. In Kentucky, the federal government pays about 70 percent of the cost for "traditional" Medicaid patients and 94 percent of the cost for the expanded population, an amount that will drop to 90 percent in 2020.

Before then-Gov. Steve Beshear, a Democrat, expanded Medicaid, the program was mainly limited to very poor pregnant women and children, disabled people and low-income elderly in nursing homes.

Asked what could be done to avoid the shortfall, Meier said, "The expansion population is an optional population."

Kentucky Democratic Chairman Ben Self told Beam that Meier "should be ashamed" for using those words. Meier told Beam after the hearing that "it was a technical term" used by the Centers for Medicare and Medicaid Services to describe populations that are not required to be covered.

Beam notes that the state is not required to cover people who qualify for Medicaid through the expansion. So far, 19 states have yet to do so. Virginia has passed an expansion, but it won't take effect until 2019; Maine voters have approved expansion, but it is in an ongoing legal battle because the governor won't allow it to be implemented; Nebraska is scheduled to vote on expansion Nov. 6.

The Bevin administration submitted a new  Medicaid plan to the federal government called Kentucky HEALTH (for Helping to Engage and Achieve Long Term Health) that was approved and set to go into effect July 1. The state estimated that the new plan would save the state $300 million over the next five years, with most of that savings a result of covering 95,000 fewer people.

However, a federal judge vacated Kentucky HEALTH just days before it was set to start, saying that federal officials had not sufficiently considered public comments about it, nor had they adequately considered the state's estimate that in five years its Medicaid rolls would have 95,000 fewer people with the plan than without it, largely for non-compliance with its requirement.

Since it was vacated, a 30-day comment period on Kentucky HEALTH that ended Aug. 18 overwhelmingly found that of the 9,397 unique comments, 8,438 or 96 percent were unsupportive, while only 373 or 4 percent were supportive, a ratio of over 20 to 1 against the waiver, according to an analysis done by the Kentucky Center for Economic Policy.

The new plan would require able-bodied adults who are not primary caregivers to work, attend school, take job training or volunteer 80 hours a month, or enroll in a drug-treatment program if appropriate. It also includes small, income-based premiums and lock-out periods for non-compliance, among other things. 

Gov. Matt Bevin has said Kentucky will end the expansion if courts block his new Medicaid plan,  and has issued an executive order putting the termination into effect six months after a final court judgment.

Beam reports that Meier told lawmakers the state had been counting on those savings to help avoid the shortfall. Meier added that the health cabinet will not eliminate the Medicaid expansion without first consulting the Republican-controlled legislature.

A group of hospital executives recently launched a campaign to encouraged lawmakers to expand the  health care tax to more providers, saying their plan would generate an estimated $372 million in 2020, Beam reports.

The group, called Balanced Health Kentucky, is motivated to save Medicaid expansion because it has significantly increased the number of people who are able to pay for their care, especially in rural hospitals, which had high rates of patients with no insurance prior the expansion. Since 2014, Kentucky's uninsured rate has dropped from about 14 percent to 5 percent, one of the sharpest drops in the nation.

Grant program for children's health enters final year; foundation plans to create a video and report to share with other communities

Breathitt County youth using fitness
equipment at Douthitt Park. (Photo:
Foundation for a Healthy Kentucky)

As a $3 million Foundation for a Healthy Kentucky grant program that focuses on children's health moves into its fifth and final year, the foundation says it will conduct the final evaluations of the seven grantee programs at the end of this year and then share the results with other communities.

The evaluations will asses not only policy changes and built environment additions, but also the extent to which the grants led to broader community engagement, a stronger coalition and the ability to leverage foundation funding for new and enhanced programs, says the release.

Most recently, the foundation reviewed the progress of the Breathitt County Health Planning Council for Children, which is part of the "Investing in Kentucky's Future" grant program. The initiative is intended to reduce the risk that today's school-aged children will develop debilitating chronic diseases as adults.

The Breathitt County partnership used its five-year, $313,800 grant, and nearly $170,000 in local funds, to combat childhood obesity as well as several other county-wide programs.

The efforts included improving facilities to encourage more outdoor activity, putting water bottle filling stations in both the local park and in schools, programs in local schools to increasing classroom movement, expanding nutrition programs, and supporting policy changes that ensure better nutrition and more physical activity in the daily lives of students and the citizens of the county.

The release notes that collaboration between the council and community partners also led to the creation of a 12-month diabetes-focused program, the expansion of the Farmer's Market and community garden, and the launch of a local seed library.

Breathitt County (Wikipedia map)

"The grant is having a magnified impact across the county," said Karen Back, a program coordinator at Kentucky River Community Care, Inc., and administrator of the grant.

One vision of the "Investing in Kentucky's Future" initiatives is that the programs could be replicated across the state. To that end, the foundation says it will create a video and other materials that can be shared in other communities.

"The foundation designed these grants to create lasting change," Ben Chandler, president and CEO of the foundation, said in the release. "To achieve that goal, we emphasized that the plans had to include the enactment of policies that make the healthier choice the easier choice and, for the obesity-prevention grantees' plans, building community spaces to spur and reinforce the habit of moving around more often."

Six of the seven grantees, including Breathitt County, chose childhood obesity prevention as their focus. The other chose to address adverse childhood experiences. In addition to the funding, the foundation also provided training and technical assistance throughout the grant period.

"While we won't necessarily see changes of obesity rates in every community during the term of the grant, we do expect to see an increase in the exercise and dietary behaviors of local children that research shows will lead to improved community health down the line," Chandler said.

The other grantees are Purchase Area Connections for Health (McCracken County), Fitness for Life Around Grant County, Partnership for a Healthy McLean County, the Perry County Wellness Coalition, the Clinton County Healthy Hometown Coalition, and the Bounce Coalition in Jefferson County.

State is moving ahead with regulations for its new Medicaid plan though it's still vacated by a federal court

By Melissa Patrick
Kentucky Health News

Though Kentucky's proposed Medicaid plan was vacated by a federal judge just days before it was set to go into effect on July 1, regulations for the changes have been proposed, and public comments were taken at a hearing Aug. 27.

The new plan, called Kentucky HEALTH for "Helping to Engage and Achieve Long Term Health," would require able-bodied adults who are not primary caregivers to work, attend school, take job training or volunteer 80 hours a month, or enroll in a drug-treatment program if appropriate. It also includes small, income-based premiums and lock-out periods for non-compliance, among other things.

A federal judge in Washington, D.C., vacated the plan on June 28, saying that the U.S. Department of Health and Human Services had not sufficiently considered the state's estimate that in five years Kentucky's Medicaid rolls would have 95,000 fewer people with the plan than without it, largely for non-compliance with its requirements. The judge sent the plan back to HHS for more review.

HHS reopened public comment for 30 days ending Aug. 18. A random sample of 200 comments by Kentucky Health News found opponents outnumbering supporters by 7 to 1. The liberal-leaning Kentucky Center for Economic Policy said it examined the 9,397 unique comments and found that 96 percent were unsupportive, while only 4 percent were supportive, a ratio of 24 to 1.

After the hearing on the regulations, "Opponents of the Medicaid changes questioned why the state was pushing ahead with the regulatory process when the Medicaid changes are in limbo," The Associated Press reported.

"We think that it's confusing to have regs filed on something that a federal judge has determined illegal and has blocked," said Emily Beauregard, executive director of Kentucky Voices for Health. "They've made no adjustments to this to address the concerns of the judge."

Cabinet for Health and Family Services spokesman Doug Hogan issued a statement saying that the state is optimistic that the federal government will re-approve the Medicaid changes: “It’s imperative that Kentucky HEALTH be re-approved in order to create better health, wellness, education and employment outcomes for our recipients and create sustainability for the Medicaid program.”

Jason Dunn, a policy analyst for KVH, said at the hearing, "The design of the program starts with an assumption that beneficiaries simply aren’t trying hard enough to extricate themselves from the grips of poverty. It then piles on layers and layers of red tape and penalties that are in no way designed to accomplish the primary goal of the program . . . to provide health care coverage for individuals and families in poverty."

Dunn then offered a long list of suggestions to improve the regulations, largely asking for them to be more transparent about issues that would directly affect a consumer's coverage, such as including co-payment and deductible amounts, and increased clarity around the "My Rewards" account, which allows consumers to earn "virtual dollars" to use towar dental and vision coverage, which are now part of the basic plan.

"Anything that relates to eligibility, any form that could impact your eligibility, should be incorporated into the regulations for reference," Dunn said after the hearing. "It is bizarre to have that level of change with so few details offered in the regulations."

Dunn also asked for removal of a new provision that would require a one-month break before a consumer can re-apply for benefits after discontinuance due to not meeting the work or "community engagement" requirements.

He also said the regulations should include a provision that requires consumers to be notified that half of their deductible can be rolled over to the following year if it isn't used, since consumers must make a request to transfer these funds. "This action should take place automatically," he said.

Dunn said after the meeting, "All these regulations are being filed to do things that are wildly outside what is permissible under federal law without the federal law being waived."

Others also spoke against the regulation around the issues around non-emergency medical transportation, domestic violence and issues around durable medical equipment related to non-compliant consumers.

Paducah Mayor Brandi Harless and Dr. Van S. Breeding of Whitesburg are named Healthy Kentucky Policy Champions

The Foundation for a Healthy Kentucky has named two new Healthy Kentucky Policy Champions: Paducah Mayor Brandi Harless for her leadership in enacting a stronger city smoking ban, and Dr. Van Breeding of Whitesburg for leadership in fighting the substance-use crisis in Eastern Kentucky.

Before being elected mayor in 2016, Harless worked with several community organizations to strengthen Paducah's existing smoke-free laws to include vaping of e-cigarettes, according to Michael Muscarella, executive director of ambulatory services at Baptist Health Paducah, who nominated her for the award.
"She was instrumental in helping us communicate our message to the city council and the public to gain support. Our coalitions could not have done this without Mayor Harless' wisdom and keen sense of timing," Muscarella wrote.

Harless is also the CEO and co-founder of PreventScripts, a company that promotes automated preventive medicine, through daily tracking, to help people maintain healthy habits.

"A strong leader like Mayor Harless can bring committed organizations together to transform community health," said Ben Chandler, president and CEO of the foundation. "She understands the importance of collaboration and her guiding influence with local health coalitions and agencies was key in focusing their efforts and transitioning Paducah to a comprehensive smoke-free community."

Dona Rains, director of community outreach at Baptist Health Paducah and a member of the foundation's board of directors, also endorsed Harless for the award, noting her efforts to improve the region's health and education. Rains highlighted Harless' work to develop the Purchase Area Health Connections nonprofit, which the release says has been awarded $1 million in grants, used in part for programs to decrease hospital readmission in high-risk patients.

"She is a prime example of Paducah pride: returning home to put her advance public health education and knowledge to work for the betterment of her fellow citizens," Rains said. Harless has a B.S. from Vanderbilt University and a master's in public health from Boston University, according to the news release.

Since moving to Paducah in 2009, Harless has served as a grant writer and development manager for Heartland CARES and executive director at St. Nicholas Family Free Clinic. She has also served on the boards of Child Watch, Paducah Day Nursery, and Project AIDS Orphan. She was a co-facilitator of the United Way's Impact Poverty Task Force "Getting Ahead" program. She was the president of the Paducah Rotary Club's Rotaract in 2013 and most recently graduated from the Delta Regional Authority Leadership institute and Leadership Kentucky.

Frances J. Feltner, director of the University of Kentucky Center of Excellence in Rural Health, nominated Breeding for the Policy Champion award in part for spearheading the creation of Help End Addiction For Life this year.

"HEAL is a nonprofit consortium of federal, state and local agencies, both public and private, that have combined resources to work on addiction prevention, education, treatment and recovery," says a separate news release.

HEAL has helped establish a syringe-exchange program at the Letcher County Health Department, and a partnership with Addiction Recover Care connects addicts to peer-support specialists. Since its inception, the program has provided services for 130 patients in the region, the release says.

"Dr. Breeding cares deeply about the well-being of people as is evident in his work as a physician and with the community," said Feltner, who is also a member of the foundation's Community Advisory Council. HEAL "is already making an impact. Health care agencies are coordinating efforts, more treatment is available, and overdoses are down."

Chandler said, "This is the kind of progress that can be made when committed organizations come together, share resources and collaborate to solve a community problem. Dr. Breeding's leadership in launching and energizing HEAL is exactly what the Healthy Kentucky Policy Champion Award was created to recognize and promote. He is making a difference in Letcher County and he is an example to his colleagues throughout the state."

Breeding is also known for supporting nutrition programs to combat diabetes and his efforts to increase screenings for colon cancer. He is director of clinical affairs at Mountain Comprehensive Health Corp. and is affiliated with the Whitesburg ARH Hospital; he is a native of Letcher County and graduate of the University of Kentucky College of Medicine.

Breeding and Harless are now eligible for the Healthy Kentucky Policy Champion of the Year award, which comes with a $5,000 grant from the foundation to a Kentucky-based nonprofit of the winner's choice. The winner of that award will be announced Sept. 24 at the foundation's Howard L. Bost Memorial Health Policy Forum in Lexington.

Nominations for the Healthy Kentucky Policy Champion Award are accepted at any time. A nomination must also be supported by a member of the foundation's board or Community Advisory Council; details are on the foundation's website.

Insurance expert advises: understand premiums, coverage, Obamacare subsidies and how much risk you want to assume

'Anyone buying health insurance this fall faces a daunting task: having to choose among multiple, often-complex options that offer widely varying degrees of protection," Trudy Lieberman of the Rural Health News Service reports in her latest column, syndicated to supporting organizations.

The new options include association health plans for small-business groups, short-term policies that may last from only a few months to a year (but can be renewed for three years in some states). "Then there are plans offered by church ministries that look like insurance but really aren’t," Lieberman writes. "Plus, multiple and complex options remain from the Affordable Care Act."

Trudy Lieberman, Rural Health News Service

Lieberman advises, "Before you comb through the fine print in an insurance policy, think about these major factors: The more you pay in premiums, the more you get in benefits. Many of the new options don’t have to cover all of the Affordable Care Act’s 10 essential benefits, and most insurance experts believe that in order to offer cheaper premiums, many of them won’t."

Low premiums and fewer benefits "may seem attractive," especially to older people who don't want to pay for mental-health and maternity coverage, Lieberman acknowledges. But the 10 essential benefits "also include prescription drug coverage, generous hospital coverage, emergency services, and rehabilitative services that are important to older people."

And there are pitfalls. Lieberman says some of the new policies "will limit hospital coverage to a certain number of days, or they might limit radiology services or drug coverage. The new so-called short-term policies will come with few if any regulations from the federal government or state insurance regulators."

Once you grasp the relationship between premiums and coverage, "The next big decision is how much risk you want to assume if you become seriously ill," Lieberman advises. "In other words, how much can you afford to pay out of pocket? For a large portion of Americans, the answer is not much. The Commonwealth Fund recently found that nearly half of working age adults could not pay an unexpected medical bill of $1,000 within 30 days."

Lieberman, who has covered health insurance for decades, writes, "Over the years, I’ve heard too many families say they are healthy, aren’t going to use the insurance, and might as well buy the cheapest policy possible – or none at all. I’ve interviewed many people who took that position only to end up later in bankruptcy court when unforeseen illness struck because they had no insurance and not enough money to pay the bills."

Once you understand your own situation, Lieberman says, "Look at the offerings on your state’s insurance exchange. Obamacare polices have gotten a bad rep almost since the beginning because they tend to be pricey for families that don’t receive an income-related subsidy to help cover the premium. About 87 percent of people who buy on the exchanges do get a subsidy."

And you may qualify for a second subsidy, cost sharing for people "with very low incomes who buy certain Obamacare policies. Those subsidies help pay for the deductibles and coinsurance that many of the policies require," Lieberman writes.

Lieberman asks, "What trade-offs are you prepared to make this year?" and asks you to tell her by emailing trudy.lieberman@gmail.com. For her entire column, and earlier ones, click here.

State sets rates for federally subsidized health insurance

The state Department of Insurance has approved the 2019 rates for federally subsidized health-insurance plans under the Patient Protection and Affordable Care Act, setting a slightly higher average rate for the state's leading insurer than the company requested.

Rates for Anthem Health Plans of Kentucky will increase an average of 4.3 percent. The company had filed requests for rates averaging an increase of 3.5 percent. CareSource of Dayton, Ohio, which is partnering with Louisville-based Humana Inc., will get the average 19.4 percent increase it requested.

"Since the actual premium charged will vary by individual and the plan level selected, some individuals may see a decrease in rates," the Insurance Department said in a news release. More detailed 2019 rate filing information is at http://insurance.ky.gov/ratefil.

Anthem will expand its coverage area into 34 counties it once served. Those counties will have a choice between Anthem and CareSource. However, in 16 of those counties, the only Anthem plans will use a narrow provider network, Anthem Pathway Transition HMO. In Hardin County, both Anthem networks will be available.

“Kentuckians in these specific 16 counties should take special notice before ultimately selecting their plan,” Insurance Commissioner Nancy Atkins said in the release.. “The provider network has been narrowed significantly, so individuals may find their preferred medical provider is not within the allowed network. We recognize that provider availability is a crucial factor in plan selection and want to make sure everyone is aware of this change.”

About 90,000 Kentuckians are covered under "Obamacare" policies this year. The department said it "will continue to perform outreach to answer questions for consumers" before open enrollment begins Nov. 1. It will run through Dec.15. Announcements and helpful tips will be posted on Facebook.com/KentuckyDOI. Consumers with questions can find contact information at insurance.ky.gov/contact. 

Senate bill, including McConnell items, would boost opioid fight

CJ photo by Michael Clevenger

The U.S. Senate has passed an appropriations bill that "takes aim at the next wave of the opioid crisis: drug-fueled infections like HIV and hepatitis that plague Kentucky," reports Laura Ungar of the Louisville Courier Journal. "The bill contains $5 million for the U.S. Centers for Disease Control and Prevention to improve tracking, treatment and education efforts targeting HIV and hepatitis B and C, which can be spread by shooting up drugs. Overall, it provides more than $3 billion in opioid-related funding."

Senate Majority Leader Mitch McConnell said he pushed for the funding. “The CDC is directed to prioritize high-risk areas, including 54 counties in Kentucky,” he said in a speech on the Senate floor. Ungar notes, "Those counties were among 220 across the nation that the CDC identified as most vulnerable to an HIV outbreak."

The funding is in the appropriations bill for the Department for Health and Human Services. "Other appropriations bills will have funding for opioids as well," McConnell spokesman Robert Steurer said in an email. The bills will have to be reconciled with bills passed by the House.

The Senate would give an extra $500 million to the National Institutes of Health for research on opioid addiction and pain management; and an increase of $20 million, to $120 million, to the Health Resources and Services Administration for rural opioid response. "While the opioid epidemic has affected both urban and rural counties, the burden in rural areas is significantly higher," the Senate report said. "Rural communities face a number of challenges in gaining access to healthcare in general, and substance abuse treatment in particular. CDC has found that drug-related deaths are 45 percent higher in rural communities, and that rural states are more likely to have higher rates of overdose deaths."

Suicide Prevention Week Sept. 9-15; officials and journalists are paying more attention to this growing cause of death in Kentucky

By Melissa Patrick
Kentucky Health News

In Kentucky, one person dies by suicide about every 11 hours, making it the 11th leading cause of death overall, according to data from the federal Centers for Disease Control and Prevention.

Efforts to increase suicide prevention and awareness often include "Out of the Darkness" community walks -- and those are still happening -- but the Louisville Health Advisory Board is adding something new this year called "Bold Moves Against Suicide Louisville," which will offer suicide prevention training in more than 85 locations between Sept. 9 and 15, which is National Suicide Prevention Week.

Dr. Val Slayton, a member of the advisory board's behavioral health committee, told Lisa Gillespie of  Louisville's WFPL that the training is part of the committee’s effort to bring suicides in the city down to zero. Gillespie reports that there were 584 deaths by suicide in Jefferson County from 2011 through 2015; during that period, there were 333 homicides in Louisville's county.

“The concept is that any suicide that exists may be related to an opportunity to stop that suicide,” said Slayton, who is also regional vice president for health services at Humana Inc. “And an important part of being able to stop suicide is by having individuals understand what to look for. And then how to intervene.”

The free 90-minute training is designed to teach people how to respond to someone in crisis and is taught much like CPR (cardiopulmonary resuscitation). The training is called QPR, which stands for "question, persuade, refer," and is designed to teach people how to recognize the warning signs of suicide, how to offer hope and how to get help and save a life.

People who take this training are often referred to as "gatekeepers," which the 2001 Surgeon General's National Strategy for Suicide Prevention report describes as "someone in a position to recognize a crisis and the warning signs that someone may be contemplating suicide."

The Louisville-based QPR classes will be taught in various locations, with four of them at the Foundation for a Healthy Kentucky at 1640 Lyndon Farm Court, Suite 100, on Sept. 11. Click here to see where else they are offered and to sign up.

The American Foundation for Suicide Prevention website lists six upcoming Out of the Darkness walks in Kentucky, including ones in Paducah, Greenville, Hopkinsville, Bowling Green, Madisonville and Louisville.

Other communities are stepping up their efforts around suicide prevention and awareness.

Photo provided to West Kentucky Star by
Four Rivers Behavioral Health

The West Kentucky Star reports that Mercy Health is hosting its second QPR training session on Sept. 5 from 2 to 3:30 p.m. at the Marshall County Health Department in Benton. The Star also promoted Paducah's Out of the Darkness Walk, to be held Sept. 8.

In April, the Star reported that local officials concerned about the number of people attempting suicide by jumping off bridges put up bright red signs at the foot of several area bridges that say: "You Are Not Alone" and give the number and website for the National Suicide Prevention Lifeline. "It is hoped that other regions in Kentucky will follow suit," the Star said, alluding to Kentucky's many rivers.

Samantha Powell, a certified prevention specialist at Four Rivers Behavioral Health’s Regional Prevention Center, told the Star, “It’s amazing how just a little thing like a sign can mean all the difference to someone contemplating suicide. To know there is a call they can make and someone will listen is a very effective prevention tool. I have read research about the success of signs like this from the QPR Institute and the Suicide Prevention Lifeline, and we decided that we could take a similar approach.”

Help is available for anyone who is thinking about suicide or knows someone who is considering it. The National Suicide Prevention Lifeline offers free, confidential support and answers calls throughout the day and night at 1-800-273-8255. The Crisis Text Line is also available 24/7 by texting HOME to 741741.

Other Kentucky newspapers are paying more attention to suicide. The News Journal in Corbin reported on the importance of talking about suicide to reduce stigma, and knowing the risk factors and warning signs.

The Georgetown News-Graphic recently reported about a six-day, 100-mile firefighter walk that came through Scott County Aug. 22 and ended in Lexington Aug. 24 to bring awareness to firefighter cancer, post-traumatic stress disorder, and suicide. Jennifer Peryam writes, "There were at least 103 firefighter suicides and 140 police officer suicides in 2017, according to the Ruderman Family Foundation."

Suicide reporting tips

Studies show stories about suicide may influence others to attempt it, so it's important to follow some simple guidelines when writing about it.

In its "Preventing Suicide: A Resource for Media Professionals" guide, the World Health Organization notes that suicide imitation behavior resulting from media coverage is often related to how long the suicide is covered, the intensity and repetition of the coverage, and the amount of detail given about the suicide and the individual involved.

The guide offers great detail on the best ways for reporters to write about suicide, but offers these suggestions as a quick reference:

• Take the opportunity to educate the public about suicide
• Avoid language which sensationalizes or normalizes suicide, or presents it as a solution to problems • Avoid prominent placement and undue repetition of stories about suicide
• Avoid explicit description of the method used in a completed or attempted suicide
• Avoid providing detailed information about the site of a completed or attempted suicide
• Word headlines carefully
• Exercise caution in using photographs or video footage
• Take particular care in reporting celebrity suicides
• Show due consideration for people bereaved by suicide
• Provide information about where to seek help
• Recognize that media professionals themselves may be affected by stories about suicide

Jim Pumarlo, a former newspaper editor who writes a column for community journalists, writes in his most recent piece that they should consider approaching families of suicide victims for stories about the phenomenon.

"The sensitivity of suicide almost makes the subject taboo in general conversation, and it brings a feeling of guilt or embarrassment to mention in an obituary. That is unfortunate, because suicide truly is an epidemic as the statistics underscore," Pumarlo writes. "Suicides are the kind of news that should be reported if community newspapers truly are to be the recorder of local events – a living history of our home towns. They are necessary if community newspapers are to remain relevant and represent themselves as the source of local information."
Other resources for reporting on suicide can be found on the Reporting on Suicide website and the American Foundation For Suicide Prevention. The Association of Health Care Journalists has also put together a tip sheet to help journalist responsibly write about suicide.

Here are American Foundation for Suicide Prevention suggestions on how to write about suicide (click on the image for a larger version):

17 companies that were warned to stop packaging electronic-cigarette liquids to kids have stopped; FDA warns it's still watching

Reuters photo 

All 17 companies that were warned in May to stop marketing their electronic cigarette liquids in packaging that resembled "kid-friendly food products," like juice boxes, candy and cookies, have stopped done so, says the U.S. Food and Drug Administration.

"Removing these products from the market was a critical step toward protecting our kids," FDA Commissioner Scott Gottlieb said in a news release. "We can all agree no kid should ever start using any tobacco or nicotine-containing product, and companies that sell them have a responsibility to ensure they aren't enticing youth use."

HealthDay News gave examples of the products that were targeted in the warning letters, including: One Mad Hit Juice Box, which resembled children's apple-juice boxes; Whip'd Strawberry, which resembled a dairy whipped topping; Twirly Pop, which resembled a Unicorn Pop lollipop and was shipped with one; and Unicorn Cakes, which included images of a strawberry beverage and unicorns eating pancakes, similar to those used by the My Little Pony television and toy franchise.

"When companies market these products using imagery that misleads a child into thinking they're things they've consumed before, like a juice box or candy, that can create an imminent risk of harm to a child who may confuse the product for something safe and familiar," Gottlieb warned.

The FDA said in the release that it expects some of the companies to continue selling the products, but with revised labeling, and that it will continue to monitor the situation. "We expect to take additional, robust enforcement actions over the next few months that target those who we believe are allowing these products to get into the hands of children," Gottlieb said.

More than 2 million middle- and high-school students reported using e-cigarettes in 2016, and  the availability of flavored-liquids is a major reason teens use them.

In Kentucky, about the same number of high-school students smoke traditional cigarettes as e-cigarettes, around 14 percent, according the the 2017 Youth Risk Behavior Survey. However,  about 45 percent of them reported that they had ever tried and electronic vapor product.

The Coalition for a Smoke-Free Tomorrow is scheduled to host a half-day conference Dec. 10 to provide the latest information available on e-cigarettes, vapes and other electronic nicotine delivery systems.

The conference will be held at the Foundation for a Healthy Kentucky offices in Louisville, but will include "live-watch events" at two or three additional Kentucky locations. Attendance will be free, but registration is required. Agenda details and registration information will be forthcoming.

Oct. 4 Health Watch USA conference in Lexington will focus on health-care transparency and patient safety

Somerset-based Health Watch USA will hold its 12th annual Healthcare Transparency and Patient Safety conference Oct. 4 in Lexington.

This year's conference will look at the importance of nursing in the prevention of adverse events, how infectious disease puts both patients and staff at risk, the importance of patient access to their medical records and the value of patient advocacy.

Christine Pontus, associate director of the Division of Health and Safety for the Massachusetts Nurses Association, and Jonathan Rosen, the principal consultant for AJ Rosen & Associates, which provides occupational-safety and industrial-hygiene services to labor unions, government agencies and organizations throughout the U.S., will review key occupational hazards confronting nurses, including the importance of safe staffing and infection control.

Jayne O'Donnell, USA Today's health-care policy reporter, will discuss what she's learned while covering patient safety and will offer strategies for healthcare workers to use when talking to reporters about medical safety lapses. She will also discuss the roadblocks reporters face when reporting on patient safety.

Dr. Joycelyn Elders, a former U.S. surgeon general, will lead a discussion on the importance of patient advocacy, followed by six patient advocate presentations.

Lisa Danielpour, a marketing, social-media and nonprofit-management consultant, will show how giving patients full access to their records can improve patient safety and health outcomes.

The conference will run from noon to 9 p.m. at the Eastside Branch Library in Lexington and will offer continuing education credits for certain medical professionals. The conference hotel is TownePlace Suites, 1790 Vendor Way, Lexington, KY, Hamburg Shopping Center. Click here for more information and a link to register.

Muhlenberg County doctor became addicted, but turned himself in, recovered, and now runs a drug-treatment clinic

Dr. Barry Hardison of Greenville runs a drug-treatment clinic in Muhlenberg County. "What Hardison has to say isn't scientific," Beth Warren of the Louisville Courier Journal reports. "It's personal," because he is a recovering addict.

"Hardison's predicament isn't rare. Other doctors struggle with addiction, but most suffer and recover in the shadows," Warren writes. Hardison, certain he was on the path to death, did something years ago that few do. He reported his own addiction to state medical board officials — the ones who could end his career."

About 10 percent of Americans develop some type of addictive disorder, and the percentage is about the same for doctors, Warren reports: "Hardison, who is 60 and has been sober nearly 25 years, speaks out to help destigmatize the brain disease and spread his message of hope."

Every addict's story is different. Hardison's began with his anxiety as a young doctor in his home county, full of fear that he would make a mistake with a patient, Warren reports: "Each evening, he was relieved to shed his starched white coat, like a bashful kid removing a superhero costume that briefly projected a fictional boldness and strength."

Hardison became "a knowledgeable internal medicine specialist who treated patients with heart and lung diseases, high blood pressure, diabetes and other ailments," but "About a year after becoming an internist, Hardison developed a high fever and severe aches from the flu. A doctor prescribed Lortab, a popular and potentially addictive opioid that was then considered a harmless and effective pain killer," Warren writes. "In an instant, Hardison's pain dissipated. So did his fears and anxieties."

"I had never felt that normal," he told Warren. So, he "kept taking a couple of pills on the weekends for a reprieve from the pressures of work. Eventually, Hardison's weekend habit swelled to two or three pills a day to quell his insecurities. He became addicted, needing more and more just to avoid being sick. Eventually, Hardison popped 30 to 40 pills just to get through the day."

When he reported himself to the state Board of Medical Licensure, "He was referred to the Hazelden center in Minnesota, which later merged with the Betty Ford Center," Warren reports. "After a month of in-patient treatment, he went back to work. He knew if he relapsed and his commitment to recovery waned, the board could suspend his medical license. . . . Medical board officials watched him for five years, ordering random drug screenings."

"After several years juggling his own recovery and internal medicine, Hardison decided to make a big change," Warren writes. "He would take what he learned from his struggles and help others who are addicted."

Justice Department gives Eastern District of Kentucky a new prosecutor to fight fentanyl, U.S. Attorney Duncan says

The chief federal prosecutor for the eastern half of Kentucky says his office is getting a new prosecutor dedicated to fighting fentanyl, the powerful opioid that was found in more than half the people who died of drug overdoses in the state last year.

U.S. Attorney Rob Duncan

"We will aggressively prosecute cases involving the distribution of fentanyl and other synthetic opioids — because with these drugs, there is no such thing as a small case," U.S. Attorney Robert M. Duncan Jr. wrote in an op-ed for the Lexington Herald-Leader.

Attorney General Jeff Sessions announced in July that Kentucky was one of eight states that would be getting a total of 10 fentanyl prosecutors.

"The Eastern District of Kentucky is at Ground Zero in the overdose crisis," Duncan wrote. "During 2017, in the 67 counties comprising our district, we had 894 overdose deaths, approximately 61 percent of the resident overdose deaths for the entire state. More alarmingly, the top five counties in the commonwealth, with the highest per capita overdose death rates, are all in our district. Similarly, four of the top five counties with the most fentanyl-related overdose deaths are also in our district."

The top five Kentucky counties for overdose deaths in 2017 were Estill, Kenton, Campbell, Boyd and Mason. The next five (Jessamine, Montgomery, Harrison, Franklin and Madison) are also in the district.

The anti-fentanyl effort "is based on a successful initiative in Manatee County, Florida, where law enforcement aggressively prosecuted fentanyl-distribution cases, helping in the reduction of overdose death rates," Duncan wrote. "The program resulted in a significant number of federal prosecutions."

Duncan said his office "will investigate and aggressively prosecute doctors who prey on opioid addiction here in Kentucky and defraud the government in the process. Finally, as part of our mission to reduce access to all illegal drugs, we will continue our support of the Organized Crime Drug Enforcement Task Force, a multi-agency effort to disrupt and dismantle the most significant drug trafficking and criminal organizations." (Read more)

Federal grants of $100,000 each will create an opioid response network in Northeast Ky., fight childhood obesity in Western Ky.

Two Kentucky organizations have received $100,000 grants from the federal Health Resources and Services Administration that will be used to address two different health issues that plague our state: opioids and childhood obesity.

The Northeast Kentucky Area Health Education Center will use its grant money to establish a regional Opioid Crisis Response Network in collaboration with St. Claire HealthCare, Pathways Inc., Sterling Health Solutions, and the Gateway District Health Department.

“Due to the scope of the opioid epidemic, no single organization can hope to solve it alone,” David A. Gross, administrative director for education and research with St. Claire, which hosts the education center, said in a news release. “But by bringing together a regional medical center, a district health department, a clinic system, and a behavioral health entity, I am confident we will come up with ideas that have the potential to make a meaningful impact on the epidemic within northeastern Kentucky.”

The Opioid Crisis Response Network will be tasked with developing a plan to address opioid use disorder and access to substance abuse treatment within the hospital's 11-county service region, which includes Bath, Carter, Elliott, Fleming, Lewis, Magoffin, Menifee, Montgomery, Morgan, Rowan, and Wolfe counties.

As part of the one-year HRSA Rural Health Network Development Planning grant project, members of the network will come up with one or two best ideas that are considered feasible.

Several suggestions have already been made, including: increasing opioid-related continuing education opportunities for medical providers; advocating for additional syringe exchange programs; establishing a long-term detoxification unit or a women’s rehabilitation facility; and increasing the number of health care professionals who are able to provide medication-assisted treatment.

The Purchase District Health Department also received one of the $100,000 federal grants and will use it to create the Purchase Area Health Connections Network, according to a spokesperson from HRSA. The department serves Ballard, Carlisle, Fulton, Hickman and McCracken counties.

This project will add at least seven new organizations to the health department's network to work on the issue of childhood obesity in far Western Kentucky. The new partners will represent educational institutions, community-based organizations, and a parks department. The ultimate goal of this project is to create a Childhood Obesity Community Action Plan, which will create a toolkit for communities to use around this issue.

Ky. reviewing how to regulate short-term health policies that aren't so short any more; health expert advises to read the fine print

Image: The National Council for Behavioral Health

A 43-year-old woman went on a search for a short-term health insurance plan in Louisville that would cost less than an Obamacare exchange plan and found one for $393 a month -- but then she read the policy's fine print.

“I started looking at the details,” Dania Palanker told Lisa Gillespie of WFPL. “They only covered $3,000 towards prescription drugs, but if I ended up needing an expensive drug, I’d end up hitting a max. They exclude certain pre-existing conditions, birth control, pregnancy coverage and mental health.”

She added: "Some hospital services aren’t covered, [like] if you’re admitted on a Friday or Saturday for a non-emergency. If you didn’t know to read through your insurance, to think that could become problematic.”

"In that situation, the policyholder would have to pay for the hospital visit," Gillespie reports.

She notes that Palanker doesn't really need health insurance and is actually an assistant research professor at Georgetown University’s Health Policy Institute, "but what she described is a situation many Kentuckians could find themselves in later this year if they buy a short-term, 'bridge' insurance policy."

Such plans are not new. Under an Obama-era rule they were limited to three months, but since the Trump administration changed the rule in August, these short-term, limited plans can now be sold for up to a year and can be renewed or extended for up to three years.

"A report by the federal government estimates there were fewer than 200,000 people with these plans last year, but that’s expected to increase by more than 600,000 by 2019," Gillespie reports.

Gillespie reports that a host of influences will make these short-term, limited plans more attractive to Kentuckians, including the removal of the individual mandate in 2019, which currently requires everyone to have health insurance or pay a tax penalty, and the likelihood that these plans will be more affordable to those who made too much money to qualify for any financial help on the Obamacare exchanges.

Add to that, Gillespie writes that these plans will be far more lucrative for insurance brokers to push because they will get a "healthy commission" for selling them, especially since the brokers who still sell Obamacare plans now get little to no commission, compared to when it was first rolled out.

Cody Michael, director of client and broker services at brokerage firm Independent Health Agents, told Gillespie that Obamacare exchange market insurers may get between $0 to $20 a month for each enrolled person, whereas short-term insurers pay up to 30 percent of whatever the plan costs. So for example, 30 percent of that $393 short-term plan found in Louisville would add up to about $118 a month for the broker.

Joel Thompson, an insurance broker in Eastern Kentucky, who tells his clients that these plans have "more holes than Swill cheese,"told Gillespie that he worries these plans will draw people away from the Obamacare marketplace, leaving only the sickest and therefore most expensive policyholders on these plans, which could "jack up prices up even more," Gillespie writes.

“That’s the real danger of the short-term plans, that they will wreck the [Obamacare] market from within, and it will fulfill the prediction that President Trump made of the ACA imploding,” Thompson told Gillespie.

Sheila Schuster, a health care advocate in Kentucky, told Gillespie that she worries that consumers considering short-term plans won’t understand what they’re buying. This concern is supported by a 2014 Kaiser Family Foundation survey that found of the nearly 1,300 adults surveyed about health insurance terms and concepts, nearly one-third of them gave correct answers to four or fewer of the 10 questions asked on the survey.

Kaiser Family Foundation chart; click on it to view a slightly larger version

Palanker, of the Georgetown health policy institute, recommended that consumers consider the entire cost of a plan, and what they’d have to pay in the event a short-term health plan didn't pick up part of a medical bill.

States can decide if they will allow these plans to be sold for year-long periods and a spokeswoman for the Kentucky Department of Insurance, Susan West, told Gillespie that the state is reviewing the new policy. “If necessary [we’ll] promulgate a regulation or recommend legislation if the Department determines changes to the federal regulatory requirements are necessary to protect Kentucky consumers,” West said.

"States are also allowed to include a “renewability guarantee” in short-term plans, which would cost a percentage of a monthly premium and protect consumers from premium increases or coverage denials should they fall ill," Gillespie writes.

Hospital executives want lawmakers to tax other providers (and lower the rate) to help pay for Medicaid expansion population

The expansion of Medicaid to nearly 500,000 more Kentuckians "must be preserved," according to a group of hospital executives who launched a campaign to persuade legislators to expand the state tax on health-care providers to help pay for it, Deborah Yetter reports for the Louisville Courier Journal.

Norton Healthcare Vice President Riggs Lewis, the group's president, said at an Aug. 22 news conference in Frankfort that the expanded tax would raise enough revenue to fund the expansion, even as Medicaid costs continue to increase, Yetter reports. "Our group believes that conservative, comprehensive health-care tax reform can make that a reality," Lewis said.

According to Gov. Matt Bevin's administration, Kentucky's Medicaid budget is facing a $200 to $300 million shortfall over the next two years and that will nearly double when Kentucky's federal Medicaid match increases from its current 6 percent to 10 percent in 2020.

Yetter reports that the group, called Balanced Health Kentucky Inc., asks lawmakers "to consider expanding a tax now paid by hospitals, nursing homes and a few other health providers to others that don't pay, such as physicians, dentists and mental health counselors."

Lewis added that expanding this tax to other providers "would boost state funds available to draw federal money, which covers most of Kentucky's Medicaid costs," Yetter writes. At the same time, the hospitals would like to see the tax rate lowered. A chart from the Balanced Health website shows who pays what:

The federal government now provides about 80 percent of the $11 billion a year Kentucky spends on Medicaid. The state provider tax currently generates about $300 million a year; hospitals pay about $182 million of that

Board members of the group include executives from Norton Healthcare, Baptist Health, Appalachian Regional Healthcare, Manchester Memorial Hospital (in the hometown of Senate President Robert Stivers) and St. Elizabeth Healthcare, Yetter reports. An executive from Taylor Regional Hospital is also listed on their "volunteer team."

The expansion of Medicaid to people who earn up to 138 percent of the federal poverty level in 2014 under the Patient Protection and Affordable Care Act resulted in more Kentuckians being able to pay for their care, especially in rural hospitals, which had had high rates of patients with no insurance. Since 2014, Kentucky's uninsured rate has dropped from about 14 percent to 5 percent, one of the sharpest drops in the nation.

Yetter writes that Adam Edelen, who as state auditor examined Kentucky hospitals' finances prior to the expansion, said that Medicaid expansion had created a "reversal of fortune for many rural hospitals that had been struggling."

"It's been their salvation," Edelen said at the news conference. "You can't overstate how important the Affordable Care Act has been to rural hospitals."

Lewis acknowledged that any tax increase would have to be approved by lawmakers and said that the groups only suggestion was that it be "lower and broader," Yetter reports.

Interactive site shows potential effect in Senate President Stivers' district.

On a webpage titled "Who will lose coverage?" the Balanced Health Kentucky's website offers an interactive map of Kentucky that shows how many of the 500,000 Kentuckians who gained coverage through the expansion are in each county, the number of hospitals in that county and how many employees are hired by those hospitals. The map also breaks this information down by state legislators in both chambers, and by congressional districts.

Yetter reports that the campaign got mixed reviews.

Jason Bailey, executive director of the left-leaning Center for Economic Policy, told her that while his organization doesn't oppose a tax on other health providers, he pointed out that hospitals already benefit from a "freeze" that lawmakers placed on what hospitals must pay in 2006. He suggested that lawmakers consider lifting that freeze because hospitals' revenue has greatly increased since then.

"They aren't contributing more than they were 12 years ago and they're making a lot more money," Bailey said.

Sen. Morgan McGarvey, D-Louisville, told Yetter the proposal could lead to a way to permanently fund the expansion. "The alternative is unplugging it," he said. "You can't just take 500,000 people off health care."

But Jim Waters, president of the Bluegrass Institute, which promotes smaller government and lower taxes, told her that his organization would rather see Medicaid downsized by getting more people into jobs with health coverage. "I think the goal should be reducing that number," he said.

Emily Schott, a spokeswoman for the Kentucky Medical Association, gave Yetter a cautious statement: "The Kentucky Medical Association will review any research and data presented on provider taxes to determine the impact on physicians and their patients."

And though neither Senate or House Republicans, who hold majorities in their respective chambers, were ready to make a comment on the proposal, Yetter reports that Lewis said the group has been presenting their proposal to legislative leaders, who have shown interest, but no commitment.

Yetter writes that "the proposal comes at an uncertain time for Medicaid in Kentucky."

A federal judge vacated the state's new Medicaid plan just days before it was set to start on July 1, saying that federal officials had not sufficiently considered public comments about it, nor had they adequately considered the state's estimate that in five years its Medicaid rolls would have 95,000 fewer people with the plan than without it, largely for non-compliance with its requirement.

The state's new plan would require able-bodied adults who are not primary caregivers to work, attend school, take job training or volunteer 80 hours a month, or enroll in a drug-treatment program if appropriate. It also includes small, income-based premiums and lock-out periods for non-compliance, among other things.

Bevin has said Kentucky will end the expansion if courts block his plan, and has issued an executive order putting the termination into effect six months after a final court judgment.

Foundation for a Healthy Kentucky report documents its change from a small philanthropy to 'an influential statewide advocate'

Under new leadership, the Foundation for a Healthy Kentucky "led or funded work to change dozens of state and local laws and policies in 2017 to help make Kentuckians healthier," including much greater efforts to "reduce smoking and exposure to tobacco emissions," the foundation says in its annual report.

The foundation is "making tremendous strides in transitioning from a relatively small health philanthropy toward an influential statewide advocate for policies that improve health across large populations," said Mark Carter, chair of the foundation's board of directors and CEO of Passport Health Plan.

Foundation CEO Ben Chandler and Gov. Matt Bevin announce
a plan to help keep Medicaid beneficiaries keep their coverage
under Bevin's changes in the program. (AP photo by Adam Beam)

Ben Chandler, a former congressman and state attorney general who became president and CEO of the foundation two years ago, said the effort accomplished "the largest cigarette tax increase in the history of the commonwealth, from the first Republican-led legislature in a century!" (Chandler is a Democrat.) The tax was raised 50 cents a pack, to $1.10; the foundation and its Coalition for a Smoke-Free Tomorrow wanted a $1 increase, saying tobacco companies would mask the increase with temporary coupons and discounts, which they are offering.

Carter says in the report, "We’re now moving into a front-line role" as "an influential advocate for policies that improve health. . . . We’re excited about the potential of this coalition to tackle one of the significant health issues in the commonwealth – high tobacco use."

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Kentucky's health problems are broad and deep, and the foundation lacks the resources to tackle them all, so it must be selective, Carter says: "We must set challenging health improvement goals, but we also must narrow our focus so we can achieve them. In addition, we must engage community and health leaders in working together to be successful."

The 18-year-old foundation says that while it shifted "to more of a focus on front-line policy advocacy than philanthropy," it still made $1,002,724 in grants in 2017, supporting "access to health care, active living, healthy eating, and resilience in children," the report says. It put $1,635,339 into programs, advocacy and research on tobacco policies, health disparities, the substance-use crisis, the Patient Protection and Affordable Care Act and Gov. Matt Bevin's proposed changes in Medicaid.

An event of the Clinton County Healthy Hometown Coalition

The foundation divides its work into three areas: tobacco use reduction, health policy, and "Investing in Kentucky's Future," a five-year-old program aimed at improving children's health through local pilot projects. Those include the Breathitt County Health Planning Council for Children, the Clinton County Healthy Hometown Coalition, Fitness for Life Around Grant County, Louisville's Bounce Coalition, the Partnership for a Healthy McLean County Coalition, the Healthy Paducah Chapter of the Purchase District Area Connections for Health Coalition and the Perry County Wellness Coalition.

The foundation's report identifies four major recipients of its help for work in health policy:

Ky. Center for Smoke-Free Policy T-shirt 

The Kentucky Center for Smoke-Free Policy, which provides "science-based strategies for advancing smoke-free policies on the local level and educating citizens and policymakers about the importance of smoke-free environments," the report says. The center conducts research on the topic and is run by University of Kentucky nursing Professor Ellen Hahn, the state's leading anti-smoking advocate.

The Kentucky Equal Justice Center, an advocate for low-income Kentuckians and other vulnerable members of society, which reaches out to them with educational programs, helps them enroll in Medicaid, and advocates policies that help them. It was one of the nonprofit poverty-law centers that got a federal judge to block Gov. Matt Bevin's plan to change Kentucky Medicaid.

Kentucky Voices for Health, a coalition of lobbying and other advocacy groups that support the 2010 Patient Protection and Affordable Care Act and the state's 2014 expansion of Medicaid under the act. It also advocates "policies to increase access to care, improve children’s health and increase the number of smoke-free jurisdictions in Kentucky," the foundation's report says.

Kentucky Youth Advocates, which "supports the foundation’s policy priority area of improving the health of Kentucky’s children through statewide policies," the report says.

The foundation co-sponsors the Kentucky Health Issues Poll, the Howard Bost Memorial Health Policy Forum, research such as the recent study of health in Appalachia, and independent health journalism by KET and Kentucky Health News. KHN is also supported by UK's Institute for Rural Journalism and Community Issues, which publishes it.

The report for 2017 is available as an interactive website here. The foundation is funded by an endowment created from the charitable assets of Kentucky Blue Cross Blue Shield when it ceased to become a mutual insurance company and became part of Anthem Inc. Its mission is to address the unmet health needs of Kentuckians by developing and influencing policy, improving access to care, reducing health risks and disparities, and promoting health equity," it says. Its website is www.healthy-ky.org.

Dan Martin, rural health champion in Western Kentucky, dies at 92

Dr. Dan Martin
(Photo from Madisonville Messenger)

Dr. Dan Martin, a leader in rural health for Western Kentucky, died Aug. 14 at the age of 92.

The Harvard Medical School graduate moved to Madisonville in 1965, where he served in many roles to improve the health of his community and surrounding areas.

He served for many years as medical director of the Hopkins County Health Department, where he established a dentistry clinic, later named in his honor. He was the executive director of the Trover Clinic Foundation and was instrumental in bringing a medical residency program to Madisonville from the University of Louisville; and he helped found the Western Kentucky Area Health Education Center and a nurse anesthetist program.

He is also credited with much of the growth of the Madisonville Community College and helped create health and human-services organizations throughout the community.
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In appreciation for his service, the Kentucky Rural Health Association created an annual award, the Dan Martin Award, for lifetime achievement in improving rural health care in Kentucky, presented each year at its annual meeting. Martin was named its first recipient in 2003.

"His dedication to improving rural health care in Kentucky and passion for medical education extended until the end of his life," says his obituary in The (Madisonville) Messenger.

Prior to coming to Kentucky, Martin served in the Navy during World War II as a hospital corpsman working with blind soldiers at the Philadelphia Naval Hospital and the New York Institute for the Education of the Blind. He was also an associate professor of preventive medicine at the University of North Carolina-Chapel Hill.

Martin was preceded in death by his wife, Gladys C. Martin; and his brother, William T. Martin Jr. He is survived by his children, Dan "Andy" Martin Jr. of Atlanta, Dr. Joel Martin (Julie) of Thousand Oaks, Calif., Dr. Paul Martin (Dana) of Atlanta, and Dr. Nina Martin of Nashville; and five grandchildren.

A memorial service will be held at First Presbyterian Church of Madisonville at 4 p.m. Saturday, Sept. 29, with visitation beginning at 2 p.m. Memorial contributions may be made to Mahr Park Charitable Trust, P.O. Box 339, Madisonville KY 42431.