Sunday, March 31, 2019

Resolution to require study of response to hepatitis A outbreak, and recommendations to avoid a repeat, failed in the legislature

Hepatitis A vaccine (USA Today photo by Nikki Boliaux)
The state Cabinet for Health and Family Services won't have to conduct a study of its response to the hepatitis A outbreak that has killed at least 52 in the state and is the nation's worst outbreak of the liver disease. It also won't have to make recommendations to the General Assembly "to ensure that future responses to outbreaks are more effective," as a legislative resolution would have directed.

The Senate-passed resolution directing the study and recommendations wasn't brought up for a vote in the House on the last day of the session, "despite broad bipartisan support," reports Deborah Yetter of the Louisville Courier Journal.

The sponsor of the resolution, Senate Democratic Leader Morgan McGarvey of Louisville, told Yetter that he didn't think it failed because of any opposition to the measure. "Rather, he said, he thinks it got caught in the crush of last-minute legislation that kept members of the House wrangling over other, more controversial bills almost till midnight," he said.

McGarvey said he will "demand answers" about how state officials responded to the outbreak, and Rep. Joni Jenkins, D-Shively, "said she expects lawmakers will pursue the matter with the cabinet," Yetter reports. Jenkins said, "It is a national embarrassment that we've handled it so poorly."

"The Courier Journal reported in February that a slow response over the past year by state public health officials to an outbreak of the contagious liver disease appeared to contribute to what became the the nation's largest and deadliest outbreak," Yetter notes.

Saturday, March 30, 2019

Drug makers' payments to doctors may influence their choice of what drugs to prescribe, and that can cost patients real money

By Trudy Lieberman
Rural Health News Service
      Peggy, an Indiana woman and reader of this column, recently sent me a lengthy email about her 94-year-old mother who is rapidly spending down her minimal savings to pay for prescription drugs.
      Peggy didn’t hold out much hope that prices would come down before it was too late for her mom.  But she succeeded in lowering her mom’s drug costs, and what she learned along the way can be helpful to others strapped by high pharmaceutical bills.
      Her mother is typical of many women in old age who have only a tiny financial cushion to absorb the continual price hikes imposed by the drug makers.  She was raised during the Depression, didn’t work much outside the home, lived in a condo her son bought, and then moved to an assisted-living facility almost two years ago.
      The facility’s $3,100 monthly fee, plus drug copays, bit into her savings, which totaled about $30,000 when she moved to assisted living.  Government benefits earned by Peggy’s father who served in the Korean War, a very small pension from a former employer, and Social Security benefits cover all but about $600 of the assisted-living fee. The rest comes from her savings, which now are about half what they were in 2017.
      While most of her mother’s drug copays and other out-of-pocket pharmaceutical expenses have been manageable, Peggy explained that it was the $313 copay for a three-month supply of a well-known, heavily advertised blood thinner, which a cardiologist had ordered, that was the biggest culprit depleting her mother’s savings.
      That was the price her mom was paying when she hit Medicare’s infamous “donut hole” last year.
      Peggy said that every time her mom visited the physician, the doctor told her she was lucky to take the expensive blood thinner instead of the other “stuff” which he called “rat poison,” implying a cheaper drug was inferior, even dangerous. Peggy said that at every visit, he said she was fortunate to be taking something better.
      Then a family member discovered, a database maintained by the Medicare program that reveals the money pharmaceutical companies pay doctors in speaking, research and consulting fees, and for food and drink expenses. Her mom’s cardiologist had received nearly $80,000.
      Peggy had a bad feeling about the doctor, and switched her mom to another physician who kept her on the high-priced drug for two months. Then she was diagnosed with anemia, taken off blood thinners and prescribed low-dose aspirin.
      In the meantime, Peggy’s husband had a heart attack and developed a blood clot.  His doctor prescribed a low-cost blood thinner that’s been on the market for years.  She said he’s doing just fine on the “rat poison” disparaged by her mother’s first doctor. His cost: a $6 copay every 30 days.
      For a long time, impartial medical experts have thought that the choice of drugs and devices may be related to payments doctors receive from drug and device companies.
      Since 2014 the Physician Payments Sunshine Act requires drug and device makers to report to the government the payments they make to doctors. The Medicare database is a treasure trove of some 11 million payments to physicians.
      The online publication ProPublica found that drug and device makers gave more than $1 billion to doctors and hospitals from August 2013 through 2016.  Some individuals have received payments in the millions.
      Still, the drug and device database may be one of health care’s best-kept secrets. 
      A study published in the British Medical Journal found that only about 3 percent of respondents said they knew their doctor had received payments from the medical industry. Unlike Peggy’s family, they had no idea that Medicare’s Open Payments database existed.
      Most Americans don’t readily switch doctors, even in the face of overwhelming evidence that the doctors performed badly. The Lown Institute, a Boston medical think tank, reporting on the British study, concluded, “Maybe we should be more open to switching doctors based on their relationship with industry.”              
      Peggy had some advice of her own: “Do the research. Did the doctor receive money to push the drug? Ask questions?  How much does the drug cost? Is it really a better alternative?”
      Do you have an experience about health insurance you’d like to share or a question you’d like to ask? Write to Trudy at

Friday, March 29, 2019

State health department funds mobile syringe exchange for Laurel, Whitley, Knox, Clay and Jackson counties

A mobile syringe exchange will go to five Eastern Kentucky
 counties: Knox, Laurel, Whitley, Clay and Jackson. (WYMT-TV) 
Five Eastern Kentucky counties will soon have a mobile syringe exchange to minimize the spread of infectious diseases and to help get people who are addicted to drugs into treatment, Justin Kase reports for WYMT-TV in Hazard. It is expected to be running in two months.

A specially outfitted van, called a Mobile Harm Reduction Unit, is funded by a grant from the state Department for Public Health and will serve adjoining Knox, Laurel, Whitley, Clay and Jackson counties. All but Jackson are among the top 54 counties in the nation with an increased risk of outbreaks of hepatitis C and HIV due to intravenous drug use.

Mark Hensley, the executive director of the Laurel County Health Department, told Kase that the mobile exchange will offer many of the same services as stationary ones, including HIV and hepatitis C testing, hepatitis A vaccines, information about addiction treatment, and a peer counselor aboard.

Each of the counties in the program has an established syringe exchange in place. Hensley said Laurel County opened its syringe exchange about two months ago, and participation has been a bit slow. He told Kase that he expected better participation with the mobile van because it might help to break down some of the barriers associated with syringe exchange programs, such as "reliable transportation or just fear of the program itself."

The plan is for the unit to spend one day in each county before moving on to the next. Locations have not been determined. "We might establish four different locations within the county, you know, maybe try to hit the four corners of those rural areas," Hensley told Kase.

20 test positive for E.coli and six of them are hospitalized, mostly in Central Kentucky; state health department searching for source

E. coli symptoms (Graphic by JR Bee, Verywell Health)
Twenty Kentuckians have tested positive for an infection caused by a strain of E. coli bacteria, and public health officials say they have not yet identified the source of the outbreak, the state Department for Public Health said.

Investigators said some element of food distribution is the likely cause of the outbreak, which has struck both children and adults, mostly in Central Kentucky.

The health department reports that no deaths have been linked to the outbreak, but six people have been hospitalized.

Health-care providers across the state have been alerted to watch for patients with quick-onset diarrhea, which can be associated with E. coli. The release says this is a particular strain of E. coli that produces a type of toxin, called Shiga toxin, that can be dangerous for those infected.

“Exposure to E. coli bacteria can be debilitating and potentially life-threatening, especially for small children and individuals with weakened immune systems," said Public Health Commissioner Dr. Jeff Howard. "With this in mind, the Department for Public Health has taken swift action to identify patients, ensure appropriate testing, and follow-up care as we work to determine the source."

Howard encouraged everyone to be aware of the signs and symptoms of E.coli infections and to seek care if they exhibit any of them.

Symptoms typically include stomach cramps and diarrhea, including bloody diarrhea. Symptoms usually start two to five days after consuming contaminated food. The state news release notes that the infection can sometimes lead to hemolytic-uremic syndrome, a serious complication that can cause kidney failure a week or more after the onset of diarrhea.

"State health officials are working with staff at local health departments in the counties with suspected or confirmed cases to determine the source of the infections," says the release.

To prevent E. coli infections:
  • Wash hands frequently for at least 20 seconds with soap and warm water, especially before eating,after going to the bathroom, when handling raw meat and eggs, and after handling or petting animals 
  • Thoroughly wash produce before eating
  • Thoroughly cook meat
  • Clean and sanitize food preparation areas
  • Avoid swallowing lake or pool water
  • Drink only pasteurized milk
  • Frequently clean and sanitize restrooms, including door knobs and faucet
If you believe you have an E.coli infection, call your health-care provider, write down what you ate in the week before you got sick, report your illness to the health department, and be prepared to answer questions about your illness, the health department advises.

Bill to require 'reasonable accommodations' to pregnant women at work passes on last day of legislative session

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill that allows pregnant women "reasonable accommodations" while at work, and supports breastfeeding, passed on the last day of the legislative session. It awaits action by Gov. Matt Bevin, whose decision will be final because it passed on the last day

Sen. Alice Forgy Kerr
Senate Bill 18, sponsored by Republican Sen. Alice Forgy Kerr of Lexington, gained final passage in the House on an 87-5 vote.

In presenting the bill to the House, Rep. Nancy Tate, R-Brandenburg, said it had the support of many business and pro-life groups, adding that 24 other states have passed similar laws. She stressed that the bill does not require mandatory paid parental leave.

The bill passed the Senate on 25-7 on Feb. 22, with an amendment that allows employers to choose from a list of accommodations rather than a mandatory list. It also removed a 10-day notice period for employers to alert pregnant employees of their rights, according to a state news release.

The "reasonable accommodations," which include things like more frequent breaks or being moved to a less strenuous or less hazardous position, are limited to employers with 15 or more employees. Normal anti-discrimination law applies to those with eight or more employees. The bill also requires applicable employers to provide a private space that is not a bathroom for expressing breast milk.

“Providing clarity on this issue is badly needed in Kentucky,” Kerr said in presenting the bill to the Senate. “As things stand right now, the employer and employees are forced to navigate a complex web of federal law and case law which leads to confusion and frustration. It discourages workforce participation among our women.”

The American Civil Liberties Union called the bill's passage a great victory for Kentucky families. "Senate Bill 18 provides much-needed clarity for employers and reasonable protections for pregnant workers to prevent problems before they start," ACLU-KY Advocacy Director Kate Miller said in a news release. "After working with a broad array of partners for a number of years to pass these critical protections, we are thrilled the General Assembly brought this law to final passage.”

Thursday, March 28, 2019

Statewide tobacco-free-schools bill finally passes, and the governor is expected to sign it into law, effective July 1, 2020

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill to ban the use of tobacco products in all Kentucky public schools and events finally passed on the last day of the legislative session and is on the way to Gov. Matt Bevin's desk for his signature or veto.

Sen. Ralph Alvarado
Because it was the last legislative day, Bevin's decision will be final. Sen. Ralph Alvarado, Bevin's running mate for lieutenant governor, reiterated that Bevin had told him he would sign the bill if it comes to his desk, and said he would be shocked if he didn't.

When presenting the bill to the Senate, Alvarado, a Winchester physician, said that 8,900 Kentuckians die every year from smoking; and that tobacco-related illnesses cost Kentucky nearly $2 billion each year, including nearly $600 million in Medicaid expenses.

"It's time for Kentucky to step up to the plate and protect its children," said Alvarado. "Let's get our children healthier. Let's save taxpayer money. Let's save Kentucky lives." The bill would take effect Jan. July 1, 2020.

Rep. Kim Moser
The Senate passed House Bill 11, sponsored by Rep. Kim Moser, R-Taylor Mill, by a 28-10 vote. It had passed the House 85-11, but not until two amendments were added to appease concerns about state-government overreach. One would give school boards three years to opt out of the ban; the other would allow adults to smoke on field trips or events off school property events if students are not present. 

Even with the amendments, Sen. John Schickel, R-Union, called the bill "the very definition of government overreach" and said it was "what some people would call a nanny state." He argued that the bill wasn't necessary because school boards already have the authority to pass such policies.

"We as conservative Republicans have no business dictating to local communities on matters such as this," he said. The bill leaves enforcement up to school boards.

Only 42 percent of Kentucky school districts have 100 percent tobacco-free policies, covering 57 percent of the state's students, and many of them have not updated their policy to meet new standards for electronic cigarettes, which have become a real problem in Kentucky schools.

Federal research showed a 78 percent increase in "vaping" among high school students and a 48 percent among middle schoolers in the last year alone. And though state-level data hasn't been released, focus groups led by Kentucky Youth Advocates showed a similar uptick in the state.

Alvarado also pointed to the rise in e-cigarette use among teens as a reason to pass the bill. He said that teens have no idea that one Juul pod has the same amount of nicotine as a pack of cigarettes, and that some kids are going through eight pods a day. The Juul products are the most popular among teens because they look like oversized flash drives, come in flavors and are easy to hide. 

"We're creating an entire new generation of addicts when it comes to nicotine," Alvarado said.

Speaking in favor of the bill, Sen. Reginald Thomas, D-Lexington, called it a "good start" toward improving smoking rates in the state, which he said were among the worst in the nation. This is true for both adults and teens in the state.

In Kentucky, 14.3 percent of high-school students smoke, compared to 8.8 percent nationally.  Almost as many, 14.1 percent,  use e-cigarettes, a bit above the 13.2 percent nationally, according to the 2017 Youth Risk Behavior Survey. That said, health experts have warned that e-cigarette figures are probably higher now because Juul sales have surged since the survey.

Thomas also pushed back against the government overreach argument, pointing to two school-related bills that passed this session, one to mandate the last Wednesday in September of each year as a day of prayer for Kentucky's students and another to require schools to display "In God We Trust." He said to applause from the gallery, "We are always for local control until we are against it."

Speaking in favor of the bill, Sen. Danny Carroll, R-Paducah, said that even though it had some flaws, "Anything that we can do to decrease smoking in our state to save lives is a vote worth taking."

Sen. Paul Hornback, R-Shelbyville, who voted no, said he thought passing a bill to raise the age to purchase tobacco to 21, like the one that had failed to get out of his committee this session, would have been a better way to deal with this issue.

Moser, who was in the Senate chamber when the bill passed, said, "This is just a great step in the right direction for Kentucky students."

Bonnie Hackbarth, vice-president for external affairs with the Foundation for a Healthy Kentucky, said that the bill's passage means that about 275,000 more Kentucky students will be covered by tobacco-free school policies.

"That's a huge win for the health of Kentucky and the health of Kentucky kids," she said. "It is going to reduce youth initiation and ultimately smoking rates in Kentucky"

"Tobacco conversations in Kentucky are complex and bring lots of pressures on our elected leaders, and that is why House Bill 11 is such a profound win for Kentucky's kids," Terry Brooks, executive director of Kentucky Youth Advocates, said in a news release.

He added, "Prohibiting tobacco use on school campuses creates an environment where smoking cigarettes and e-cigs is not the norm, provides positive adult role modeling, and protects students, staff, and visitors from the harms of secondhand exposure."

Alvarado called the passage of the bill "the beginning of a gradual culture change that needs to happen."

Health departments, regional mental-health centers, other entities get a pension fix, but at a cost to some employees' pensions

Teachers filled the Senate gallery. (Herald-Leader photo by Matt Goins)
As it closed up shop, the legislature gave local health departments, regional mental-health centers and other government-related agencies another reprieve from pension costs that threaten their future, but at a cost to some employees' pensions.

"Under the plan, the organizations can remain in the Kentucky Retirement Systems and begin paying a staggering 84 percent of their payroll as their share of pension contributions, which is what the rest of state government paid this year," John Cheves reports for the Lexington Herald-Leader. "Or they can leave KRS by July 2020 and pay off their pension liabilities, either with one lump sum or starting at their current rate of 49 percent of payroll and gradually increasing by 1.5 percent a year" until the liability is funded.

In organizations quitting KRS, employees hired since 2014, and all new hires, "will be enrolled in defined-contribution plans" like 401(k)s, Cheves writes. "Longer-term employees can choose whether to remain in KRS with their defined-benefits pensions or switch to a defined-contribution plan. But if they remain in KRS, their employer’s liabilities will increase.

The revised House Bill 358 "would allow most employees of the affected groups to continue accruing future retirement benefits in the current pension plan," unlike the Senate's earlier version of the bill, which would have moved most employees to "a new 401(k)-like plan," Tom Loftus reports for the Louisville Courier Journal. "Any group that leaves the pension plan or is more than 30 days late in making payments" would be moved into a 401(k)-like plan, "and pension checks to retirees from such groups could be suspended until the group gets current on its payments."

Gov. Matt Bevin had told lawmakers that he would sign the Senate's earlier version into law, but would reject any approach he thought would unnecessarily harm the badly underfunded pension plan. "Sen. Chris McDaniel, the Taylor Mill Republican who co-chaired the committee that worked out the compromise, said he hoped that Bevin would sign the bill into law, but did not know whether he would," Loftus reports. Because Thursday night was the last one of the session, "Bevin could veto it and the legislature would have no ability to override the veto."

The bill passed largely along party lines, 26-11 in the Senate shortly before 8:30 p.m. and 58-39 in the House at 11:11 p.m.

Health departments, regional mental health agencies, domestic violence shelters, rape crisis centers and other groups warmed that an increase in their pension contributions to 84 percent of payroll, from the current 49 percent, "would force dramatic cuts in services," Lofts writes. "Health departments serving 64 counties would become insolvent and likely close their doors within two years."

But the Senate did not want to merely grant relief because that would have robbed the pension plan "of money it anticipates and desperately needs. The plan is considered the worst-funded public pension plan in America with only 13 percent of the assets on hand needed to cover future benefits," Loftus notes. "The compromise bill is projected to cost that plan $799 million — forcing what is sure to be a big hike in future contributions from the remaining employer in that plan: state government."

"There's nothing but bad choices involved in this," McDaniel told reporters Thursday night. "And this (the compromise bill) is the best of all of those."

Cheves writes, "Critics of the bill complained that it was a complex measure being foisted on them in the final hours of the legislature, and that given the huge costs involved, some quasi-public agencies might not be able to afford either option available. “This doesn’t help the quasis,” said Sen. Robin Webb, D-Grayson. “It doesn’t help them. It’s a path to insolvency. It’s a path to bankruptcy.”

'Fatal Flaws' series on Ky. workplace safety wins national award for Kentucky Center for Investigative Journalism

Wednesday, March 27, 2019

Judge again blocks state's Medicaid plan with work requirements for many, says likewise for similar plan already in effect in Ark.

The order vacating federal approval of Kentucky's plan
By Melissa Patrick
Kentucky Health News

A federal judge in Washington has again blocked Gov. Matt Bevin's attempts to require many people on Medicaid to work or do other forms of "community engagement," saying that such rules don't square with Medicaid's objective to give low-income people health care.

U.S. District Judge James Boasberg also ruled March 27 against similar work requirements in Arkansas. Bevin, a Republican running for re-election, has said the U.S. Supreme Court will ultimately decide the issue. His former deputy chief of staff, Health and Family Services Secretary Adam Meier, said in a press release, "We believe that we have an excellent record for appeal and are currently considering next steps.”

The plan is called Kentucky HEALTH, for Helping to Engage and Achieve Long Term Health. It would require "able-bodied" Medicaid members to spend 80 hours a month working, going to school, taking job training, acting as a primary caregiver or getting treatment for drug abuse; make them report monthly; stop their coverage for failure to comply; and pay small premiums, based on income.

Boasberg vacated federal approval of the plan and sent it back to the U.S. Department of Health and Human Services for further review just days before it was set to launch on April 1 -- just like he did in late June, when he vacated it the first time. He said both times that HHS Secretary Alex Azar had not sufficiently considered the state's projection that its Medicaid rolls would have 95,000 fewer people in five years with the rules than without them, in large measure for failing to follow rules.

"Given a second failure to adequately consider one of Medicaid's central objectives, the court has some question about HHS's ability to cure the defects in the approval," Boasberg wrote. In Arkansas, more than 18,000 people have lost Medicaid coverage since a similar plan took effect there.

Kentucky made no real changes to its plan after Boasberg's ruling last June. However, it put more emphasis on its argument that without the new rules, Bevin would end his Democratic predecessor's expansion of Medicaid to about 450,000 people earning up to 138 percent of the federal poverty line -- many more than the forecast drop of 95,000 under his plan. The governor has issued an order ending the expansion six months after any final court decision against the plan.

The Medicaid expansion was authorized by the 2010 Patient Protection and Affordable Care Act, more often called Obamacare. The Supreme Court upheld the law in 2012 with one main exception: "Congress could not require states to adopt that Medicaid expansion by conditioning all their Medicaid funding on a decision to do so," noted Boasberg, an appointee of President Obama.

Judge James Boasberg of the District of Columbia
The high court "explained that the states could not be compelled to engage in a program they had not bargained for with 'a gun to the head.'  Kentucky, it seems, has now picked up that gun by threatening to de-expand Medicaid," Boasberg wrote.

"By definition, so this argument goes, any number of people covered by an experimental Medicaid program would be greater than the number if there were no Medicaid at all; as a result, any demonstration project that leaves any individual on a state’s Medicaid rolls promotes coverage. The court cannot concur that the Medicaid Act leaves the secretary so unconstrained, nor that the states are so armed to refashion the program Congress designed in any way they choose."

Meier replied, “The judge illogically concluded that Medicaid is all about paying for health care for as many people as possible without regard to whether this coverage actually makes people healthier. . . . We want more than to simply give someone a Medicaid card they can put in their wallet. We want a program that focuses on actually improving health outcomes. . . . Kentucky HEALTH is precisely in line with the objectives of the Medicaid program."

Meier said Kentucky HEALTH will no longer begin on April 1 and that beneficiaries will continue to have the same coverage and benefits that they currently have. Beneficiaries should contact their managed care organization or go to for the most up-to-date information.

Boasberg's decision brought immediate praise from Obamacare supporters.

Kentucky Voices for Health and our partners applaud the court’s decision to once again protect Kentuckians on Medicaid by refusing to create additional barriers to care,” said Executive Director Emily Beauregard. “Medicaid works in Kentucky, and Medicaid expansion has saved lives. Judge Boasberg’s decision sends the message that 1115 waivers must uphold the purpose of Medicaid, which is to furnish health coverage to low income people.” Kentucky HEALTH would be an experimental project under Section 1115 of the Social Security Act.

The state's slightly revised plan prompted 16 Kentucky Medicaid recipients to file an amended complaint to the original class-action lawsuit, saying nothing of substance was changed. They are represented by the National Health Law Program, the Kentucky Equal Justice Center and the Southern Poverty Law Center.

HHS's Centers for Medicare and Medicaid Services has approved waivers of the Medicaid rules to include work requirements in eight states, with seven applications pending, according to the Kaiser Family Foundation.  

The Foundation for a Healthy Kentucky struck a deal with the Bevin administration last year to help Medicaid members comply with the plan to keep their coverage. It issued a statement from President and CEO Ben Chandler saying, "The foundation recognizes that adequate health insurance coverage is one of the most cost-effective ways to improve health outcomes. For a state with some of the poorest rankings in health outcomes, coverage is critical to reduce health-care costs, particularly those costs paid by tax dollars, by increasing access to preventive services, improving medication adherence, and providing better treatment for chronic illnesses."

Chandler added, "The foundation is reviewing the court's opinion. Meanwhile, we are aware that some Kentuckians have already voluntarily taken advantage of the job training and placement services expanded under the Kentucky HEALTH framework. If the administration continues to provide the framework on a voluntary basis, the foundation plans to continue working with community organizations and other stakeholders to support Medicaid beneficiaries with accessing resources."

Man who ran drug-treatment facilities in Ironton and Portsmouth, Ohio, is indicted on drug-trafficking charges

Graffiti under the U.S. Grant Bridge in Portsmouth, Ohio
(Cincinnati Enquirer photo by Liz Dufour)
The former operator of Ohio drug-treatment facilities just across the river from northeastern Kentucky was indicted Wednesday on 34 felony counts ranging from drug trafficking to Medicaid fraud.

Paul Vernier, 56, operated Community Counseling and Treatment Services in Ironton and Portsmouth, the Cincinnati Enquirer reports. He is accused of overbilling Medicaid and illegally operating a dispensary for Suboxone, a drug used in medication-assisted treatment for addiction.

“The evidence will show that this guy abused the trust of hurting people who were looking for help and that he played the rest of us – who pay the bills – for fools,” Ohio Attorney General Dave Yost said in a press release. “Time for some accountability.”

Bevin signs bill setting deadlines for insurers to authorize medications prescribed by health-care providers
Gov. Matt Bevin has signed into law "a bill that’s expected to ease the process for getting some medications and treatments pre-approved by insurers," Darla Carter reports for Insider Louisville.

Senate Bill 54 could speed up the authorization process "to five days or less, along with other enhancements," Carter writes, and quotes Dr. Bruce Scott, a Louisville ear, nose and throat physician who is president of the Kentucky Medical Association.

“Five days is a considerable improvement for our patients,” Scott said. “It’s still five days of stress and five days of waiting, but that’s a whole lot better than what we used to have, which could often stretch on for weeks.”

KMA says the bill, sponsored by Republican Sen. Ralph Alvarado, a Winchester physician, targets "a process that has become onerous to medical providers and patients alike, with doctors’ office staffs sometimes spending hours on hold waiting to hear back from insurers," Carter writes.

Scott told her the process can lead patients “to abandon treatments that are recommended by their doctors, and it adds stress to patients who are waiting for approval of a medication, a treatment, a diagnostic study that their trusted physician has recommended to them.”

An American Medical Association survey "found that nearly 30 percent of physicians report that the prior-authorization process required by health insurers has led to serious or life-threatening events for patients," Carter reports. "The survey of 1,000 practicing physicians also found that more than a third of physicians employ staff strictly to work on pre-authorization tasks."

Insurers say they have an obligation to keep costs down. "Stephanie Stumbo, acting executive director of the Kentucky Association of Health Plans, reminded members of the House Banking and Insurance Committee that insurance companies also have to deal with headaches related to prior authorization," Carter writes.

The bill takes effect Jan. 1. It will require health plans to make decisions about urgent services within 24 hours of getting the necessary information, and on non-urgent services within five days. Scott told Carter the insurers “pushed for seven days, and the bill was originally written at 72 hours [three days], and we compromised with five days.”

Prior authorizations for maintenance drugs, usd to treat chronic conditions, will be good for a year, with some exceptions, including opioid painkillers and benzodiazepines (minor tranquilizers).

Monday, March 25, 2019

Beshear says he's investigating pharmacy benefit managers for possible overcharging, and discrimination against independents

Republican Gov. Matt Bevin and Attorney General Andy Beshear
are the most likely nominees for governor in the Nov. 5 election.
Attorney General Andy Beshear announced March 21 that he is investigating pharmacy benefit managers, the "middlemen" between drug companies and health insurers, including Kentucky's Medicaid program and state-employee health plan.

Beshear is investigating whether PBMs have overcharged the state "and discriminated against independent pharmacies," his office said in a press release, which noted that a state report "indicated two PBMs took in $123.5 million last year from the state Medicaid program by paying pharmacies a lower rate to fill prescriptions, while charging the state more for the same drugs."

The release said, "It is estimated that more than 1.5 million Kentuckians receive pharmacy benefits through Medicaid and the state employee health plan’s PBMs. Thousands of other Kentuckians receive pharmacy benefits through PBMs retained by their private insurance plans. . . . Beshear said PBMs were originally established to help companies and government programs better manage pharmacy costs, but have grown into powerful industry middlemen that go to great lengths to hide and complicate drug pricing information."

The international news agency Reuters reports, "The investigation comes against the backdrop of widespread criticism of rising costs of prescription medicines in the United States, with PBMs, middlemen who negotiate prices for employers and health insurers, coming under intense scrutiny."

The state report, titled "Medicaid Pharmacy Pricing: Opening the Black Box," was done by the state Department of Medicaid Services on orders from the General Assembly, Medicaid Commissioner Carol Steckel said upon its release, "We have additional steps that we will need to take in order to make this program fully transparent."

Beshear is the leading candidate for Democratic nomination for governor. Gov. Matt Bevin is seeking re-election and is heavily favored in the May 21 Republican primary.

Sunday, March 24, 2019

Justice secretary touts treatment over incarceration; 'We have to distinguish who we are mad at and who we are actually afraid of'

Justice and Public Safety Secretary
John Tilley (Photos by Melissa Patrick)
By Melissa Patrick
Kentucky Health News

State Justice and Public Safety Secretary John Tilley told foreign scholars visiting Kentucky Friday that treatment, instead of incarceration, is what is needed to help people who suffer from addiction -- a stand that is still a hard sell for some in Kentucky.

"The best place to treat addiction is not a prison cell," Tilley said. "And I still have policy makers in this state who think that is OK, when there is absolutely no evidence, no evidence that that approach enhances public safety."

Tilley and other experts spoke to nearly 90 Fulbright scholars from 49 countries at a University of Kentucky seminar.

Tilley said prosecutors tell him they are "hard-pressed" to find someone in the system who isn't there because of a drug-related offense, that 95 percent of their cases are related to addiction. He noted that since 1970, Kentucky's population rose 38 percent and its prison population rose 700 percent.

"We're beginning to realize that we can't change that behavior with punishment," he said. "We're not going to punish people into sobriety."

But some law-enforcement officials still oppose syringe exchanges that can prevent disease and accidents, and steer people into treatment, said keynote speaker Beth Macy, author of Dopesick: Dealers, Doctors and the Drug Company that Addicted America. "It all seems to collapse in that murky area between healthcare and criminal justice," said Macy, who began covering the opioid epidemic as a newspaper reporter in her hometown of Roanoke, Virginia.

Tilley said he is working on removing drug possession as a felony offense in Kentucky, as more than 15 states have done, "but there are too many who are unwilling to take that leap." He said at least 2,000 Kentuckians are in the prison system only for possession.

Tilley was instrumental in passing Kentucky's 2015 anti-heroin bill, as a state representative from Hopkinsville. Among other things, the bill created a system in which Kentucky counties and cities could authorize syringe exchanges; increased penalties for high-volume traffickers; allocated money for drug treatment; and let the Department of Corrections medicate inmates with opioid-use disorders.

Tilley, a Democrat, was appointed justice secretary in December 2015 by Republican Gov. Matt Bevin. "This is a nonpartisan piece of our government," he told the foreign visitors. "It's about justice and results, and we can all agree on those things."

He said Kentucky is working on many reforms to keep people with addictions out of prison, including, but not limited to: efforts to train police officers on how to recognize mental illness and addiction, and how to use crisis interventions and de-escalation techniques; using social workers in police departments to help find resources for people, instead of locking them up; efforts to help prisoners re-enter the workforce when they are released; pilot programs that offer medication-assisted therapies to inmates; and a program called the Angel Initiative in all 16 state police posts, which lets a person with an addiction to come in and be driven to the nearest treatment bed.

'A failed model' that varies unjustly from court to court

Tilley said the state must stop putting non-violent, low-level, non-sexual offenders in jail, and described how incarcerating worsens social problems.

He said Kentucky has the nation's second highest female incarceration rate, which has put more children into foster care, now numbered at  more than 10,000. "It's all tied together," he said. "We have to distinguish [between] who we are mad at and who we are actually afraid of."

Tilley pointed to research that shows addiction is a disease of relapse and requires many attempts for a person to become sober, and when you add criminal entanglements, it is a "set-up for failure."

He added, "It's a failed model. Why in the world would we try to treat what I think is a public health nightmare with a criminal justice system that was never designed to do this?"

He added that people with addictions who are arrested in Kentucky are treated differently across the state, depending on judges' understanding of addiction and the availability of wrap-around services to help offenders. "It's incredibly disparate, and it's unjust," he said. "It is injustice at its best."

Most who need treatment don't think they do, and most don't get it

Ty Borders, the director of UK's Rural and Underserved Health Research Center, told the scholars Friday that most people who have been diagnosed with substance-use disorders don't think they need treatment, and most who need treatment don't get it.

He said a national study found that only 17 percent of people with a heroin-use disorder in urban areas, and 24 percent in rural areas, thought they needed treatment; and among those with disorder involving prescription drugs, only 8 percent in urban areas and 13 percent in rural areas saw a need.

"The biggest predictor of people actually trying to get treatment for drug use disorder is whether they perceive any need for it," Borders said.

Not many more with a substance-use disorder actually got treatment.

The study found that in 2014-15, about 13 percent of Americans aged 18-64 who had a drug-use disorder got any type of treatment for it. That number was higher among those with an opioid-use disorder, around 24 percent, largely because there is a medication available to treat it, Borders said.

"These are really low rates, especially when you compare these to rates of treatment for hypertension, diabetes, cancer, et cetera," he said.

Ty Borders
On another point, Borders said that while more primary-care providers than ever are able to prescribe buprenorphine, a medication to treat opioid addiction, there are still concerns that their patients aren't getting appropriate counseling and therapy that is supposed to go with it, compared to what they would get from a psychiatrist.

He said Kentucky data show that the proportion of Medicaid patients who were prescribed buprenorphine and also received counseling at the same time increased in 2014-16, but the percentage who actually got the drug went down duruing that period.

"That means fewer people are getting access to this drug, if they had an opioid use disorder and they were covered by Medicaid," he said, adding that one reason for this could be that insurance firms that manage Medicaid  have put in prior-authorization requirements and other mechanisms that make it harder for providers to get approval for payment by the program.

Rep. Kim Moser, R-Taylor Mill, filed House Bill 121 to address this issue, but it got stuck in the Senate and is not far enough along in the process to pass on March 28, the last day of the legislative session. Moser told Kentucky Health News that it's important for patients to be able to get their medication-assisted treatment drugs without any delay because it keeps them from cycling in and out of jail or emergency rooms, and prevents overdose deaths.

Borders said there continues to be a great need for more buprenorphine prescribers in the central and western parts of the U.S., where some people have to drive more than 100 miles to get this medication.

Part of the problem is that the U.S. Drug Enforcement Administration requires health-care providers to either be board-certified to prescribe addiction medications or to take eight hours of training to get certified to prescribe, and then are only allowed to treat 275 patients annually.

Borders said research shows there are more buprenorphine prescriptions in states that expanded Medicaid to people who earn up to 138 percent of the federal poverty level, as Kentucky did. Borders attributed this to more people having access to a health-care provider and therefore the drug, and also being more able to pay for it because they have insurance.

Health departments scramble to fight hepatitis A outbreak

Peyton Manning had hepatitis C but didn't know about hepatitis
A or the outbreak until it hit him. (Michael Clevenger, Courier Journal)
The nation's largest outbreak of hepatitis A has slacked off somewhat in Kentucky, but remains a threat and local health departments are dipping into their reserves and taking unusual steps to get people vaccinated for the liver disease, which has killed 44 Kentuckians during the outbreak.

The medical director of the Lake Cumberland District Health Department doesn't usually give vaccinations, but each of her counties only had one or two nurses to do that, so Dr. Christine Weyman started giving shots, too, Laura Ungar and Chris Kenning report for the Louisville Courier Journal.

"She has gone out to vaccinate drug users who largely were spreading the virus," they report. "She once went so far as to chase two men down a street to persuade them to get the shot. (They weren't interested.) She also went to the crowded Pulaski County Detention Center, realizing the 213-bed jail with more than 400 inmates could be an excellent incubator for the virus. Right outside the jailer's office door, her health department placed a refrigerator for the sole purpose of storing vaccines."

"In many ways," Ungar and Kenning wrote, the Somerset-based department "is a microcosm of rural Kentucky's continuing struggle with hepatitis A. What's happening there reflects how Kentucky's communities with limited resources are quietly battling the nation’s largest and deadliest outbreak — learning as they go and altering their strategies to meet the many challenges they face."

The state has averaged 76 hepatitis A cases per week this year, "sometimes reaching more than 90 a week, compared with 151 a week at its peak in early November," the CJ reports, but "Kathleen Winter, an epidemiologist at the University of Kentucky, said a recent downward curve in the outbreak doesn't necessarily mean it's waning."

"We still need robust intervention," Winter told the newspaper. "It's still too early to say whether it’s really winding down. We still have individuals getting sick, being hospitalized and dying."

The story's first example was Peyton Manning, 27, "who was sleeping behind a Walmart in Lexington and spending his days shooting meth and heroin. Late last year, he admitted himself to The Healing Place in Campbellsville. Then a virus hit him. He couldn’t sleep. He couldn't keep any food down." He went to the UK hospital and recovered at his mother's home.

Manning already had hepatitis C, but said he didn't know about hepatitis A or the outbreak. "didn’t even know it was a thing," he told the CJ. "I started to watch the news. It was like, damn, I didn’t know it was that bad."

Health departments are responding "with a mix of resources," the paper reports. "In addition to using state funding, local health departments can also order federally funded vaccine through the state or buy shots using money from $233 million in county health department reserves," which "vary greatly across counties and area development districts. They're in the negative numbers in some places and reach into the millions of dollars in others."

The Lake Cumberland agency had unrestricted reserves of about $5 million when the outbreak hit in 2017, but was "trying to avoid using this as much as possible to help with the pension crisis," said Ron Cimala, its administrative director. Many health departments have said they will have to close unless the legislature keeps giving them relief from the state's new requirement for funding their employees' pensions.
Ranges of health department reserves that could be used to pay Kentucky Employees Retirement System obligations. About half of the counties are in district departments; others are independent.

Saturday, March 23, 2019

Here's a list of health-related bills in the General Assembly as legislators plan to return for their last day on March 28

Kentucky Health News
When the General Assembly returns Thursday, March 28, for the final day of its session, it could pass any number of bills, including several related to health: to make schools tobacco-free, to set up a hotline for students to report "vaping" of electronic cigarettes; to give health departments a reprieve from increased pension payments; to require children under 12 to wear helmets when riding a bicycle; and more. Here's a list of health-related bills and their status as of Friday, March 22, with colors denoting possible action:

Montgomery County reports uptick in cases of syphilis

Health officials in Montgomery County say they're seeing more syphilis cases.

"What had become a relatively rare disease is now seeing a resurgence nationwide," the Montgomery County Health Department said on its Facebook page Friday. The agency "said it has seen an increase in syphilis cases in recent months," the Lexington Herald-Leader reports.

Montgomery County (Wikipedia map)
The department said on Facebook, "The increase has initially been identified among those in the drug community, with injection drug use being a risk factor. However, health officials warn that this disease can be passed along to others outside of this group."

“This disease does not discriminate against anyone or any group,” said Kelly Allen, the department's nurse supervisor. “We want the public to be aware of symptoms in case treatment is needed and to take steps to protect themselves.”

Syphilis, a curable disease, is transmitted by sexual and other forms of contact with a syphilis sore, which is also the most common symptom. That is followed by a rash. "These symptoms may not be painful, but they shouldn’t be ignored," the department said. "Syphilis can cause severe health problems if not treated, including paralysis, blindness and even death. It can also be spread from a mother to her unborn baby."

Friday, March 22, 2019

Bevin says he exposed his nine children to chickenpox, pooh-poohs required vaccinations, misstates who requires them

By Melissa Patrick
Kentucky Health News

Gov. Matt Bevin said in a radio interview that he exposed his nine children to chickenpox instead of vaccinating them, a practice that is strongly opposed by health officials as risky.

Bevin also cast doubt on longstanding government policy of requiring vaccinations, and incorrectly attributed the requirement to the federal government rather than the state. His administration recently made it easier for parents to exempt their children from school vaccination requirements.

Bevin raised the topic on Bowling Green's WKCT, where the hosts had been discussing a lawsuit by a Northern Kentucky teenager who had been barred from playing basketball, and then from school entirely, because he had not been vaccinated for chickenpox. Host Chad Young asked Bevin about bills he might veto, but the governor said he first wanted to talk about chickenpox.

Gov. Matt Bevin
“Every single one of my kids had the chickenpox," Bevin said. "They got the chickenpox on purpose because we found a neighbor that had it and I went and made sure every one of my kids was exposed to it, and they got it. . . . They were miserable for a few days, and they all turned out fine.”

Bevin and his wife, Glenna, have nine children, ages 5 to 16, according to his campaign website.

The U.S. Centers for Disease Control and Prevention strongly discourages such "chickenpox parties," saying they are not worth the risk.

"Chickenpox can be serious and can lead to severe complications and death, even in healthy children," the agency warns. "There is no way to tell in advance how severe your child’s symptoms will be. So it is not worth taking the chance of exposing your child to someone with the disease. The best way to protect infants and children against chickenpox is to get them vaccinated."

Dr. Sean McTigue, a pediatric infectious-disease specialist at the University of Kentucky, told Kentucky Health News that the efficacy and safety of vaccines has been proven "time and time again."

McTigue, who teaches pediatrics, said "chickenpox parties" might have made sense before there was a vaccine against the disease, because its risks after infancy increase with age, and some parents wanted to make sure they got it while they were young. But in the post-vaccine era, he called such parties "ludicrous." The vaccine for chickenpox was licensed for use in the U.S. in 1995.

Centers for Disease Control and Prevention graphic
For a larger version, click on it.
Before that, the CDC reports, about 4 million Americans got chickenpox each year, over 10,500 were hospitalized and about 100 to 150 died.

Chickenpox is a highly contagious infection caused by the varicella-zoster virus that causes itchy, blister-like rash. Most children who get chickenpox recover completely, as the governor's children did, but the CDC says it can be "serious, even deadly, especially for babies, adolescents, adults, pregnant women, and people with a weakened immune system."

Shingles a risk

McTigue pointed out that a person who has had a natural chickenpox infection is at a greater risk than a vaccinated person of getting shingles, a painful skin rash that is caused by the same virus that causes chickenpox.

During the radio interview, Bevin said that vaccinating children should be a parent's decision, not the government's.

"If you are worried about your child getting chickenpox or whatever else, vaccinate your child. . . . But for some people, and for some parents, for some reason they choose otherwise," he said. "This is America. The federal government should not be forcing this upon people."

The federal government does not force states to require vaccination, only recommends it, a CDC spokesperson said. The National Conference of State Legislatures says all 50 states have laws requiring specific vaccines for students; 47 grant religious exemptions and 18 allow philosophical exemptions.

Kentucky only allows medical and religious exemptions. Chickenpox is among the diseases for which the state requires proof of vaccination, or medical documentation that the child has had it, in order to enter public kindergarten.

In 2017 the Bevin administration made it easier for parents to invoke the religious exemption to the law that requires vaccination to attend school. The new rules allow parents to download a form, have it notarized and submit it to their school upon enrollment, instead of having to get a signed form from a health-care provider.

Following that, Kentucky's rank among the states in the percentage of children with vaccinations declined, and Spectrum News reported that the number of Kentucky parents claiming the religious exemption increased 59 percent in the 2017-18 school year.

A representative of the state Cabinet for Health and Family Services told a legislative committee in 2017 that the changes had been in the works for several years, in response to complaints that a medical entity should not have authority over a religious exemption; that a co-payment was often required to get a provider's signature; and that parents and guardians were having trouble finding providers to sign the forms.

'Herd immunity' requires mandatory vaccinations

Bevin's assertion that governments shouldn't require vaccinations doesn't take into account the principle of "herd immunity," which occurs when enough people have been immunized against a disease to protect others who are not immunized. Some are not because their immune systems are too weak to allow them to be vaccinated, or because they are too young to be vaccinated.

People with weakened immune systems include those with cancer, especially if they are being treated with an aggressive chemotherapy, people who have had bone-marrow transplants, people who have had an organ transplant, people with auto-immune disorders, like rheumatoid arthritis or Lupus, or people with acquired immunodeficiency syndrome, or AIDS.

"Those people are absolutely reliant upon herd immunity because we can't immunize them," McTigue said. "The only way that we have to protect them is to ensure that everybody around them is immunized so that the chances of them actually coming into contact with somebody who has one of these very infectious viruses or bacteria is very, very low."

He said herd immunity is vitally important to protect babies, because they can't be vaccinated for measles, mumps and rubella or chickenpox until they are a year old because these vaccines are made with very weak, but live viruses.

"So, every single baby less than one year old is unvaccinated and unprotected against those conditions," he said. "And the young babies who cannot yet be immunized against those conditions are exactly the patients that we worry about the most if they get those infections because they are at greatest risk of complications." He added, "A varicella infection to a newborn baby can be fatal."

It should also be noted that parents who chose to not get their children vaccinated also depend on herd immunity to keep their children healthy. But the practice puts others at risk, McTigue said.

"Not only does it put your child at risk of getting severe and potentially life-threatening illnesses, but it also puts other people in the community at risk of getting serious and potentially life-threatening infections," he said.

The case that set the stage

After a chickenpox outbreak at Assumption Academy, a Catholic school in Boone County, the Northern Kentucky Health Department on March 14 told students without proof of vaccination or immunity against chickenpox to not attend school until further notice, and their extracurricular activities were canceled.

Jerome Kunkel, an 18-year-old senior at the high school who has not been been vaccinated, filed suit against the department, claiming "health officials violated his freedom of religion and other rights by ordering students without the vaccine to not attend school or extracurricular activities," Max Londberg reports for the Cincinnati Enquirer. The suit says Kunkel opposes the vaccine on religious grounds "due to its being derived from aborted fetal cells."

The vaccine was developed in the 1960s with cells from a legally aborted fetus, but no aborted fetuses being used today, McTigue said. He said the Catholic Church supports the vaccine.

In response to Bevin's comments, the Kentucky Democratic Party called on the governor to clarify his position on vaccination against the hepatitis A virus, which has killed 44 people in the state.

“Kentucky is currently experiencing the worst outbreak of hepatitis A in the country. It is a major public health risk at this point. The last thing we need is Governor Bevin suggesting that immunization is not important," the party said on its website. "Governor Bevin should reassure the public that he supports the recommendation of the entire medical community with respect to controlling an outbreak of Hepatitis A, which is immunization.”

The governor's office did not return a request for further comment. Bevin, a Republican, is running for re-election this year; his running mate is state Sen. Ralph Alvarado, a Winchester physician who has publicly endorsed vaccinations.

Youth suicide rates are increasing in Ky.; Courier Journal does in-depth stories, in hopes of spurring conversation to find out why

The editor of the Louisville Courier Journal posted this note with the package of stories,
Some readers may find one quotation in this story offensive.

In a package of stories, Allison Ross of the Louisville Courier Journal reports on the rising number of youth suicide deaths over the past five years in Kentucky. She tells the tales of four Kentucky youth who died by suicide, and explores the causes and challenges that youth suicide presents.

One of the stories is about Marcus Pryor, a 12-year-old whose mother, Sandy Metzmeier, said he took a full bottle of antidepressant pills because a friend was being mean to him.

Metzmeier, from Flaherty in Meade County, told Ross that her son called for help from his bedroom and she rushed him to the hospital, where he was treated and sent home, but later he began to have seizures and died the next morning. he was one of 10 Kentucky children under the age of 15 to die of suicide in 2017, Ross reports.

Metzmeier said Marcus told her that he didn't want to die: "He did something drastic and stupid to get attention and thought Mommy would fix it."

Kentucky suicide deaths among those who 18 and younger nearly doubled in 2015, to a total of 34, compared to only 18 in 2014. The numbers kept going up and remained high, Ross notes: "In 2016, 36 killed themselves. In 2017, there were 36 more. At least 10 were not yet old enough to drive. And in 2018, preliminary records show 31 children and teens in Kentucky took their own lives. That same year, more Kentucky children and teens died of suicide than by homicide."

Ross reports that Jefferson County has already seen four youth suicides in the first three months of 2019. "If children were dying of the flu like this, it would be in the paper every day," Sara Oliver of Louisville, who lost her 16-year-old daughter to suicide in 2017, told Ross.

Oliver said she thought her daughter's first iPhone was the start of her anxiety, noting that she was "unable to detach herself from her phone and probably had a warped impression of success," even though she was on her school's homecoming court, sang in Ballard High School's madrigal choir, and played lacrosse.

Experts, advocates and families call for more research and resources to prevent youth suicide.

"Doctors say youth and teens don't have enough access to behavioral health services," Ross writes. "Advocates say there's not enough money going to intervention programs such as suicide hotlines, where desperate people must sometimes be put in a queue until they can talk to a counselor. And researchers say they need more grants to better research how influences such as social media and bullying play a role in why some children kill themselves and others do not."

Patti Clark, who oversees substance abuse and suicide prevention programs for the Cabinet for Health and Family Services, told Ross that some of the increase in youth suicide numbers may be attributed to better reporting, because the state has worked to educate county coroners about properly labeling a suicide. But she added that this doesn't entirely explain the uptick.

Clark told Ross that she was particularly concerned about surveys showing increased suicidal thoughts and actions by younger children, a national trend that include Kentucky.

"In the past decade, the U.S. suicide rate for children and teens 18 and younger has grown by more than 90 percent — with 2017 suicide deaths in this age group hitting the highest count since data collection began in 1999," Ross writes, citing the Centers for Disease Control and Prevention.

Jefferson County Coroner Barbara Weakley-Jones told Ross that her office saw nine youth suicides last year and has already had four in the first quarter of this year, with some of them very young: "You didn't use to see a 6- or 9-year-old commit suicide."

Ross tells the story of a 10-year-old fifth grader named Seven Bridges who died by suicide in January. His story resonated across the country in part because his mother, Tami Charles of Louisville, alleged that school bullying was to blame.

In response to the increase in youth suicides, Jefferson County Public Schools held its first "Bullying and Suicide Prevention Summit" March 21 for school counselors, principals and administrators to talk about prevention and response strategies, Liz Schlemmer reports for WFPL.

Researchers say that youth suicide is rarely caused by a single factor and that they "have noted that some trends, such as bullying and suicide-related behavior, are closely related and that access to firearms has also been linked to a greater chance of suicide," Ross reports.

The CDC and other organizations note that suicide is not solely a mental health concern and that many people who kill themselves had no previous known mental health conditions.

And experts say that, despite efforts, there are still not enough resources for mental-health and crisis help. Ross writes that other issues include stagnant Medicaid reimbursements and an unfunded mandates to provide suicide prevention training in schools, with no oversight over the types of programming presented.

In telling the story of Alechia Click and her ex-husband Ron Click's son, Ronnie, who was 17 when he killed himself in October, Ross reports on the many unanswered questions that Alechia deals with in her loss, like "Was there anything I could have done?" Ron told Ross that there were no warning signs that his son was considering killing himself.

"I told him I loved the shit out of him, and I was proud of him," he said, his voice cracking. "It still didn't help."

Courier Journal Editor Richard Green, in a special note attached to the story, says the paper chose to write about these individual suicides in "hopes a larger community-wide conversation begins about why death by suicide is happening far too frequently among our youth."

Warning signs that may indicate risk of suicide include:
  • Talking about wanting to die or interest in killing oneself
  • Looking for a way to kill themselves, like searching online or buying a gun
  • Talking about feeling hopeless or having no reason to live
  • Talking about feeling trapped or feeling unbearable pain
  • Talking about being a burden to others
  • Increased use of alcohol or drugs
  • Acting anxious or agitated; behaving recklessly
  • Sleeping too little or too much
  • Withdrawing or isolating oneself
  • Showing rage or talking about seeking revenge
  • Extreme mood swings
If you are having thoughts of suicide, the National Suicide Prevention Lifeline is 800-273-8255.

Albany doctor pleads guilty to illegal prescription of painkillers; federal prosecutors said some resulted in deaths

A doctor in Appalachian Southern Kentucky pleaded guilty March 18 to 13 counts of prescribing controlled substances without any legitimate medical purpose and outside the course of professional medical practice, the U.S. attorney for the Western District of Kentucky announced March 22.

Dr. Michael L. Cummings, 63, a family practitioner in Albany, faces a maximum prison term of 145 years, a combined maximum fine of $7.25 million, and three years of supervised release. Sentencing is scheduled for June 19 before District Court Chief Judge Greg Stivers. 

Cummings' plea agreement with the Justice Department says that in 2012-14, he prescribed the painkillers Oxycodone, OxyContin, Endocet and hydrocodone, the anti-anxiety medicines Valium and alprazolam, the appetite suppressant phentermine, and the sleep aid zolpidem tartrate, all "without any legitimate medical purpose and outside the course of professional medical practice."

Two years ago, Cummings was charged with 18 counts of illegal prescriptions "resulting in the deaths of three patients" in 2014, the U.S. attorney's office said at the time. The news releases used initials to identify the decedents; one of those named in the 2014 release was not named in the latest one. "Cummings was initially charged with prescribing drugs that resulted" in those deaths, "but federal prosecutors dropped those three counts of the indictment," Bill Estep reports for the Lexington Herald-Leader.

"Federal prosecutors said in a motion that Cummings was one of the most prolific prescribers in the state between 2012 and 2014, even though Clinton County has only about 10,000 residents," Estep reports. That "caught the attention of federal authorities, who investigated along with Kentucky State Police. Police watched Cummings’ office in Albany and saw cars from outside the county and state, and also got records showing his patients were filling prescriptions outside the county." That indicated “a medical practice that attracted and/or catered to people who were either abusing or diverting prescription pain medications,” the plea agreement said.
Read more here: